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THE 


ANATOMY 

OF 

THE  HUMAN  EAR, 

ILLUSTRATED  BY  A 

SERIES  OF  ENGRAVINGS, 

OF  TIIE  NATURAL  SIZE; 

WITH  A TREATISE  ON 

THE  DISEASES  OF  THAT  ORGAN, 

THE  CAUSES  OF  DEAFNESS, 

AND 

THEIR  PROPER  TREATMENT. 


BY  THE  LATE 

JOHN  CUNNINGHAM  SAUNDERS, 

DEMONSTRATOR  OF  PRACTICAL  ANATOMY  AT  ST.  THOMAS** 
HOSPITAL,  FOUNDER  AND  SURGEON  OF  THE  LONDON 
INFIRMARY  FOR  CURING  DISEASES  OF  THE  EYE. 


FIRST  AMERICAN  FROM  THE  SECOND  LONDON  EDITION. 


WITH  NOTES  AND  ADDITIONS  BY 

WM.  PRICE,  M.  D. 

ONE  OF  THE  SURGEONS  TO  THE  PENNSYLVANIA  HOSPITAL,  &C. 


PHILADELPHIA: 

PUBLISHED  BY  BENJAMIN  WARNER,  AND  SOLD  ALSO  AT  HIS 
STORES  IN  RICHMOND,  VA.  AND  LOUISVILLE,  KEN  * 

AND  BY 

W.  P.  BASON,  CHARLESTON,  S.  C. 


1821. 


FRANKISH,  PRINTER. 


' 


. 


THE  ANATOMY 

AND 

IDSDUilSISS 

OF 

THE  HUMAN  EAR. 


To  A ST  LEY  COOPEB,  Esq.  F.  E.  S, 


Sir, 

The  dedication  of  this  book  to  you 
indulges  at  once  my  gratitude  and  my 
ambition.  I avail  myself  of  this  opportu- 
nity to  acknowledge  the  many  obligations 
which  your  kindness  and  uniform  attention 
have  conferred  on  me.  With  pleasure  I 
render  this  tribute  to  your  friendship. 

In  seeking  the  authority  of  your  name,  I 
have  consulted  the  means  of  enhancing  my 
own  reputation.  AFbo  can  more  properly 
patronize  a work  on  the  Ear,  than  one  who 
has  signalized  himself  by  the  elucidation  of 
its  diseases? — Who  so  well  appreciate  the 
merits  which  it  may  possess,  or  shield  its 
defects  against  the  severity  of  criticism? — 
The  world  is  acquainted  with  your  profes- 
sional abilities,  and  respects  your  opinion. 
Your  enthusiasm  and  unremitting  endea- 
vours to  cultivate  the  department  of  Surgery, 
are  displayed  in  the  works  which  you  have 


Ylll 


already  given  to  the  public;  and  it  is  con- 
fidently predicted  that  your  talent  for  ob- 
servation, quickened  by  an  ardent  desire  to 
improve  the  science,  will  contribute  fresh 
accessions  to  our  knowledge,  and  add 
lustre  to  the  profession. 

But  it  is  not  merely  by  your  own  labours, 
great  as  they  are,  that  you  benefit  society. 
Placed  as  a principal  teacher  in  the  first 
medical  school  in  Great  Britain,  you  impart 
a portion  of  your  energy  to  your  pupils, 
many  of  whom  will  be  excited  by  the 
influence  of  your  example  to  professional 
exertions  not  unworthy  of  the  place  where 
they  received  their  education. 

I am,  Sir, 

With  respect  and  attachment. 

Your  most  obedient  Servant, 

J.  C,  SAUNDERS. 
Ely  Place , March  12,  1806. 


I 


ADVERTISEMENT 

TO  THE 

AMERICAN  EDITION. 


Since  the  publication  of  Mr.  Saunders’  work 
on  the  Ear,  medical  literature  has  been  enrich- 
ed by  a valuable  treatise  on  the  same  subject 
by  Mr.  Curtis,  a pupil,  and  the  most  distin- 
guished successor,  of  Mr.  Saunders,  in  the 
treatment  of  diseases  of  that  organ. — Vari- 
ous other  essays,  and  cases  of  a similar  cha- 
racter having  since  appeared  in  the  British 
Journals,'  it  has  been  the  object  of  the  Edi- 
tor to  embody  in  the  present  edition  of  Mr. 
Saunders,  all  the  valuable  information  to  be 
derived  from  these  sources,  so  as  to  render 
the  work  as  complete  a Monograph  on  the 
Diseases  of  the  Ear,  as  the  present  state  of 
Surgery  will  admit  of. 

Philadelphia,  JYov.  20th,  1821. 


iUDWEBEttS. 


SPffc 


The  very  high  estimation  in  which  this  work 


is  held  by  the  Medical  World,  and  hv  the 
Anatomical  Student  in  particular,  has  indu- 
ced the  present  publishers  to  bring  forward  a 
new  edition  in  an  octavo  volume,  that  its  use- 
fulness may  become  more  general  from  the 
portableness  and  the  convenience  of  its  form, 
as  well  as  on  account  of  the  reduced  price  at 
which  it  can  be  disposed.  Another  consi- 
deration has  had  much  weight  in  determin- 


ing its  size,  that  of  making  it  uniform  w ith 
Mr.  Saunders’s  work  on  the  Eye;  both  of 
which  it  is  presumed  w ill  long  remain  exam- 
ples of  the  deep  researches  of  a mind,  whose 
wonderful  penetration  left  no  subject  unde- 
veloped to  which  he  applied  its  powers,  and 
w hich  gained  for  its  possessor  a fame  in  the 
annals  of  science,  which  will  only  cease  to 
exist  w hen  science  itself  shall  fail  to  benefit 
mankind. 


ANATOMY 


OF 

THE  HUMAN  EAR. 

CHAPTER  I. 


A Description  of  the  External  Part  of  the 
Ear , viz.  the  Auricle  and  the  Meatus  Ex- 
ternus. 

The  Human  Ear,  of  which  I propose  to 
treat  in  the  following  anatomical  descrip- 
tion, is  an  organ  of  the  most  curious  and 
exquisite  structure,  composed  of  many 
parts,  all  elaborately  formed  for  the  re- 
ception, transmission,  and  perception  of 
sound.  The  complexity  and  minuteness 
of  many  of  its  constituent  parts  render  it  a 
Aery  difficult  subject  for  description.  It 

will,  therefore,  be  expedient,  in  order  to 

£ 


2 


increase  the  perspicuity  of'  the  explanation, 
to  adopt  a division  that  shall  be  easy,  natu- 
ral, and  consistent. 

The  analysis  of  the  human  Ear,  shews, 
that  it  is  composed  of  three  parts, evidently 
constructed  for  different  purposes.  The 
external  part  is  constructed  relatively  to 
the  medium  by  which  the  sense  of  sound 
is  excited,  and  its  configuration  is  well 
adapted  to  collect  the  pulses  of  the  air,  and 
to  direct  them  inwardly  towards  the  seat 
of  hearing.  The  internal  part  is  the  seat 
of  hearing  itself,  and  consists  of  a number 
of  cavities,  that  contain  a membranous 
texture,  on  which  the  sentient  extremities 
of  the  auditory  nerves  are  expanded.  The 
middle  part  is  a beautiful  piece  of  machi- 
nery, connected  with  the  external  and  inter- 
nal parts,  and  designed  to  transmit  the  im- 
pulses of  the  air  to  the  auditory  nerves. 

The  terms  external,  middle,  and  inter- 
nal, here  employed  to  denote  the  three 
divisions  of  the  Ear,  express  nothing  more 
than  their  position.  They  have  been 
adopted,  defective  as  they  are,  since  lan- 


n 


guage  does  not  afford  any  terms  more  com- 
prehensive, whether  we  would  derive  them 
from  the  uses  of  each  division,  or  the  differ- 
ent parts  which  it  comprehends.  But  the 
inadequacy  of  the  terms  cannot  impair  the 
propriety  of  the  division.  It  is  in  fact  the 
division  of  Nature,  and  results  from  the  dif- 
ferent functions,  severally  performed  by  the 
different  parts. 

The  external  part  has  obtained  in  com- 
mon language,  the  appellation  of  the  Ear, 
a word  full  as  often  used  to  express  the 
whole  organ.  To  avoid  the  confusion  of 
applying  the  same  general  term  to  the 
whole  as  to  one  of  its  parts,  I shall,  in  this 
treatise,  call  it  the  Auricle. 

The  Auricle  is  placed  by  the  side  of  the 
head,  and  joined  by  its  root  to  the  Os 
Temporis;  The  margin  of  that  side,  which 
is  turned  from  the  head,  is  considerably 
elevated,  and  the  general  'concavity  within 
the  margin  is,  by  the  rise  of  the  surface, 
subdivided  into  certain  curvilineal  grooves, 
all  of  which  tend  towards  a canal,  formed 


4 


in  the  root  of  the  Auricle,  the  Meatus  Ex- 
ternus. 

The  Concha,  the  deepest  and  largest 
depression  of  the  Auricle,  is  situated  at  the 
entrance  of  the  Meatus  Externus.  The 
boundaries  of  the  Concha  are  formed  by 
four  eminencies,  viz.  the  Tragus,  Helix, 
Antihelix,  and  Antitragus.  The  Tragus 
and  Helix  bound  it  before,  the  Antihelix  and 
Antitragus  behind. 

The  Tragus  is  placed  immediately  be- 
hind the  Condyle  of  the  lower  jaw.  It  rises 
into  a little  knob,  and  lies  on  the  fore-part 
of  the  Meatus  Externus. 

The  Helix  arises  from  the  Concha,  which 
it  partially  divides  into  a superior  and  infe- 
rior depression.  It  advances  from  its  origin 
a little  before  the  Tragus,  is  soon  reflected 
in  the  form  of  a curve,  and  in  its  descent 
gradually  becoming  less  distinct,  is  lost  in 
a soft  pendulous  substance,  the  Lobe. 

The  Antihelix  lies  within,  and  opposite 


5 


to  the  Helix,  and  is  formed  with  a similar 
curve.  Above,  it  consists  of  two  ridges, 
which  unite,  and  the  eminence,  formed  by 
their  union,  is  continuous  below  with  a little 
projection,  called  the  Antitragus,  from  its 
possessing  a situation  directly  opposite  to 
the  Tragus. 

A considerable  groove  is  formed  between 
the  Helix  and  Antihelix,  which  increases  in 
depth,  as  it  approaches  the  Concha,  where 
it  terminates.  Another  groove,  formed  be- 
tween the  two  ridges  of  the  Antihelix,  joins 
the  former  just  before  its  termination  in  the 
Concha. 

These  are  the  most  remarkable  appear- 
ances of  this  side  of  the  Auricle.  The  op- 
posite side  possesses  little  that  requires  par- 
ticular attention.  It  may  be  said  to  be  con- 
vex, but  in  the  general  convexity  the  pro- 
jections of  the  Concha,  Helix,  and  Antihelix, 
are  readily  distinguis  liable. 

The  Auricle  is  composed  of  an  elastic 
cartilage,  and  the  common  integuments. 
Its  figure  is  chiefly  derived  from  the  carti- 


6 


lage,  in  which  the  eminences  and  depres- 
sions, already  mentioned,  are  fashioned, 
except  the  lower  part  of  the  Helix  and  the 
Lobe.  These  are  nothing  more  than  dn- 
plicatures  of  skin,  containing  a portion  of 
fat. 

The  root  of  the  Auricle  is  disposed  in  the 
form  of  a tube,  but  it  is  to  be  observed,  that 
the  cartilage  itself  does  not  complete  the 
circle.  This  is  effected  by  the  junction  of 
the  Tragus  to  the  Helix,  by  a ligamentous 
fascia,  and  the  common  integuments. 

This  tubular  part  of  the  Auricle  is  united 
to  a tubular  part  of  the  Os  Temporis,  and 
they  form  by  their  union  the  Meatus  Ex- 
ternus,  a canal  leading  to  the  interior  parts 
of  the  Ear.  The  length  of  this  canal  varies 
in  different  subjects  from  an  inch  and  a 
quarter  to  an  inch  and  a half,  and  its  area 
gradually  diminishes  as  it  approaches  its 
termination.  Its  shape  is  rather  eliptical 
than  cylindrical,  its  direction  inwards,  with 
a slight  declination.  It  is  not  rectilineal 
but  winding.  It  is  first  turned  upwards, 
then  downwards,  and  is  again  slightly  bent 


7 


near  its  termination.  Its  lower  part  is 
longer  than  the  upper,  for  it  terminates,  as 
it  were,  by  an  oblique  section,  which  is 
closed  by  the  Membrana  Tympani,  in  such 
a manner,  that  the  Membrana  Tympani 
makes  an  obtuse  angle  with  the  canal  above, 
an  acute  angle  below. 

The  common  integuments,  having  co- 
vered the  cartilage  of  the  Auricle,  enter  the 
Meatus  Externus,  and  having  reached  the 
bony  portion  of  this  canal,  become  ex- 
tremely thin.  They  form  a lining  for  the 
Meatus,  and  terminate  in  a pouch,  that  is 
placed  in  contact  with  the  exterior  surface 
of  the  Membrana  Tympani. 

The  skin  of  the  Auricle,  and  that  of  the 
Meatus  Externus,  are  both  perforated  with 
numerous  small  holes,  the  orifices  of  seba- 
ceous follicles  in  the  former,  in  the  latter  of 
the  ceruminous  ducts. 

The  Ceruminous  Glands  themselves  are 
placed  exteriorly  to  the  Cutis  of  the  Meatus 
Externus,  in  the  interstices  of  a reticular 
membrane.  They  are  about  the  size  of 


8 


Millet  seed,  approach  to  a spherical  or 
elliptical  form,  and  are  tinged  of  a slight 
yellow  by  the  Cerumen  which  they  contain. 
Each  little  gland  sends  a small  duct,  that 
opens  in  the  Meatus  Externus,  and  dischar- 
ges the  Cerumen,  which  is  there  found, 
and  answers  the  purpose  of  keeping  the 
Membrana  Tympani  moist. 

The  Auricle  is  retained  in  its  situation  by 
the  ligamentous  connexion  of  the  cartilage 
with  the  bone  of  the  Meatus  Externus,  and 
by  a strong  ligament,  that  passes  from  an 
acute  point  of  the  Helix  to  the  Zygomatic 
process  of  the  Os  Temporis. 

The  description  just  given,  is  taken  from 
the  Adult  Ear.  In  the  Fcetal  Ear,  the 
parts  of  which  are  less  completely  formed, 
the  Meatus  Externus  is  almost  entirely 
cartilaginous  and  membranous.  Instead  of 
a process  of  the  Os  Temporis  forming  a 
considerable  part  of  the  Meatus  Externus, 
nothing  more  is  discovered  in  the  Foetus 
than  a slender  piece  of  hone  of  an  elliptical 
figure,  but  not  making  a complete  ring. 
It  contains  the  Membrana  Tympani,  and 


9 


adheres  to  the  rest  of  the  Os  Temporis  only 
by  its  extremities.  The  space  between  the 
Tragus  and  this  ring  of  hone,  is  occupied 
by  a very  dense  membrane,  that  seems 
placed  there  as  a kind  of  bed,  in  which 
hone  is  afterwards  deposited.  As  ossifica- 
tion extends,  the  different  parts  of  the  Os 
Temporis  are  consolidated.  Indeed  soon 
after  birth,  the  Foetal  ring*  is  united  to  the 
rest  of  the  hone,  and  is  gradually  elongated 
during  the  progress  of  growth,  until  it  oc- 
cupies the  place  of  the  membranous  sub- 
stance  just  mentioned. 

It  has  already  been  said,  that  the  Meatus 
Externus  terminates  obliquely,  and  that  its 
lower  part  is  longer  than  the  upper,  xk 
little  groove,  making  three-fourths  of  an 
Ellipse,  is  formed  in  its  extremity.  It  con- 
tains the  Membrana  Tympani. 

The  Membrana  Tympani  is  the  partition 
between  the  external  and  middle  part  of  the 
Ear,  and  is  so  called  from  its  closing  the 
Orifice  of  a cavity  named  the  Tympanum. 


c 


10 


CHAPTER  II. 


A Description  of  the  Middle  Part  of  the  Ear. 
viz.  of  the  Tympanum , of  the  Machinery 
contained  in  the  Tympanum , and  of  certain 
Parts  annexed  to  each. 

The  Tympanum  is  the  cavity  that  lies  im- 
mediately at  the  bottom  of  the  3Ieatus  Ex- 
ternus.  It  is  formed  between  the  squamous 
and  petrous  portions  of  the  Os  Tcmporis. 
Its  figure,  although  irregular,  approximates 
to  the  spherical. 

The  regularity  of  the  bony  superfices,  in 
which  the  Tympanum  is  placed,  is  inter- 
rupted by  numerous  little  pits,  spiculse,  and 
foramina.  The  depth  of  the  Tympanum 
is  not  equal  in  all  directions.  Its  greatest 
depth  is  opposite  to  the  aperture  of  the 
Vestibule,  the  least  to  the  apex  of  the 
Cochlea.  The  former  scarcely  exceeds 


11 


three  lines,  the  latter  is  hardly  two.  The 
length  and  of  breadth  the  Tympanum  are 
nearly  equal,  each  measuring  about  the 
third  of  an  inch. 

The  Mastoid  cells  are  placed  behind  the 
Tympanum.  They  are  large  and  numerous, 
freely  communicate  with  each  other,  and 
open  by  a large  aperture  in  its  posterior 
and  superior  part.  They  may  be  consi- 
dered as  a part  of  the  Tympanum,  for  the 
communication  is  perfectly  tree,  and  they 
are  both  lined  with  a delicate  and  vascular 
membrane,  that  secretes  a fluid  to  moisten 
the  internal  surface,  at  the  same  time  that 
it  answers  the  purpose  of  a periosteum  to 
the  bony  superfices. 

In  the  anterior  and  lower  part  of  the 
Tympanum  is  placed  the  aperture  of  the 
Eustachian  Tube.  The  Eustachian  Tube 
proceeds  from  the  Tympanum,  passing  ob- 
liquely forwards  and  inwards  by  the  side 
of  the  internal  Ala  of  the  pterygoid  process 
of  the  Os  Sphenoides,  and  opens  in  the  su- 
perior and  lateral  part  of  the  Pharynx 
above  the  velqrn  Palati  Mollis.  The  Eu- 


12 


stachian  Tubes  reach  their  termination  in 
the  Pharynx,  with  so  great  a degree  of  con- 
vergency,  that  if  they  were  produced,  they 
would  meet  each  other  at  the  hack  of  the 
Vomer. 

The  Eustachian  Tube  is  composed  of 
bone  and  cartilage.  The  bony  portion  is 
lined  with  the  same  membrane  as  the 
Tympanum;  the  cartilaginous  with  a re- 
flection of  the  membrane  of  the  Pharynx, 
which  is  blended  so  intimately  with  the 
former,  that  no  line  of  distinction  is  per- 
ceptible. 

The  bony  portion  is  an  elongation  of  the 
Tympanum,  and  ends  in  a scabrous  ex- 
tremity, that  receives  the  cartilage.  The 
cartilaginous  portion,  as  it  is  called,  is  not 
entirely  composed  of  cartilage.  It  consists 
on  the  fore  part  of  a dense  membranous 
substance,  which,  together  with  the  carti- 
lage, affords  a surface  for  the  origin  of  two 
muscles,  the  Levator  Palati  Mollis  and  Cir- 
cumflexus  Palati. 


The  two  portions  united,  constitute  a 


18 


tube  about  an  inch  and  an  half,  or  an  inch 
and  three  quarters  in  length,  of  an  elliptical 
figure,  the  major  axis  of  which  is  vertical. 
The  magnitude  of  this  tube  varies  much 
in  different  places.  Its  orifice  in  the  Tym- 
panum is  about  two  lines  in  its  major  axis. 
Hence  it  gradually  lessens,  until  it  does 
not  exceed  one.  This  magnitude  it  pre- 
serves for  a short  space,  but  at  the  junction 
of  the  bony  portion  to  the  cartilaginous,  it 
suddenly  enlarges,  and  continues  to  in- 
crease, until  it  terminates  in  the  Pharynx; 
where  it  opens  by  an  orifice,  large  enough 
to  admit  a goose  quill. 

Besides  the  apertures  already  mentioned, 
viz.  the  aperture  of  the  Mastoid  cells,  and 
that  of  the  Eustachian  Tube,  two  others 
present  themselves  in  the  interior  super- 
ficies of  the  Tympanum.  These  are  the 
aperture  of  the  Vestibule,  and  the  aperture 
of  the  Cochlea;  the  former  called  the  Fe- 
nestra ovata,  the  latter  the  Fenestra  ro- 
tunda. 


The  Fenestra  ovata  is  placed  in  the 
upper  part  of  the  internal  superficies  of  the 


14 


Tympanum,  in  an  oblique  direction,  but 
parallel  with  the  plane  of  the  Membrana 
Tympani.  It  is  not  perfectly  elliptical. 
Its  upper  part  is  the  segment  of  an  ellipse, 
the  lower  a straight  line,  connecting  the 
extremities  of  the  segment.  It  exactly  re- 
sembles the  base  of  the  Stapes,  a bone, 
hereafter  to  be  described,  which  shuts  it 
up,  and  therefore  in  the  recent  state,  this 
aperture  is  not  to  he  discovered  unless  the 
Stapes  be  displaced. 

The  Fenestra  rotunda  is  lower  than  the 
Fenestra  ovata,  and  nearer  the  Mastoid 
process.  This  aperture  is  also  shut  in  the 
recent  state,  by  a membrane  of  an  oval 
figure,  similar  to  the  Membrana  Tympani, 
and  like  that,  convex  internally.  It  is 
placed  someway  within  the  Fenestra  ro- 
tunda, and  is  not  discoverable  without  dis- 
section, even  in  the  Foetal  Ear,  in  which 
the  hone  is  less  evolved. 

The  Tympanum  is  separated  from  the 
Meatus  Externus  by  the  intervention  of  the 
Membrana  Tympani. 


15 


Tile  Membrana  Tympani  is  pellucid  and 
of  and  elliptical  figure.  Its  major  axis  is 
placed  neither  vertically  nor  horizontally, 
but  obliquely.  It  is  fixed  in  the  elliptical 
groove,  at  the  termination  of  the  Meatus 
Externus,  except  in  the  posterior  and  su- 
perior part,  where  the  groove  is  deficient, 
There  it  is  attached  to  a rough  surface  of 
the  bone. 

From  what  has  been  already  said  of  the 
oblique  termination  of  the  Meatus  Exter- 
nus,  it  must  be  evident  that  the  Membrana 
Tympani  is  very  much  inclined,  and  that 
its  superior  and  posterior  part  is  not  so  far 
distant  from  the  orifice  of  the  Meatus  as 
the  inferior  and  anterior.  It  is  a thin  pel- 
licle of  membrane,  strengthened  without 
by  the  cuticle  of  the  Meatus  Externus,  and 
within  by  the  lining  of  the  Tympanum. 
Although  always  in  a certain  state  of  ten- 
sion, yet  it  is  not  a plane:  on  the  contrary, 
it  is  verv  convex  towards  the  Tympanum, 
and  the  convexity  is  of  a conical  figure,  the 
apex  of  which  is  in  the  centre.  To  this  the 
Manubrium  of  the  Malleus  is  attached. 


16 


The  Membrana  Tympani  is  exceedingh 
Vascular.  Numerous  little  vessels  descend 
along  the  Manubrium  of  the  Malleus,  from 
which  diverging  twigs  proceed.  These 
form  beautiful  and  intricate  inosculations 
with  a plexus  of  vessels  ranged  in  the  mar- 
gin of  the  membrane. 


The  Tympanum  contains  four  little  hones, 
articulated  with  each  other,  and  forming  a 
chain  of  communication  between  the  Mem- 
brana  Tympani,  and  the  Membrane  of  the 
internal  part  of  the  Ear,  in  which  the 
sense  of  hearing  is  seated.  They  are  the 
Malleus,  Incus.  Os  Orbiculare,  and  Stapes. 

The  first  of  these  is  the  Malleus,  v hich 
may  he  divided  for  the  purpose  of  descrip- 
tion into  three  portions,  namely,  the  Manu- 
brium, the  Head,  and  Processus  Gracilis. 

The  Manubrium  adheres  to  the  Mem- 
brana  Tympani.  It  is  incur vated,  particu- 
larly at  its  extremity,  which  reaches  the 
centre  of  the  Membrana  Tympani.  and 
draws  it  into  its  convex  state. 


The  Head  is  joined  to  the  Manubrium 
by  a slender  portion  of  the  bone,  which  some 
have  called  the  neck.  It  makes  a consider- 
able angle  with  the  Manubrium,  and  its  di- 
rection is  obliquely  upwards  and  backwards. 
It  is  of  a globular  form,  but  on  one  side  the 
surface  is  irregular,  to  fit  it  for  a firm  artic- 
ulation with  the  Incus. 

The  Processus  Gracilis  passes  off  just 
between  the  Head  and  Manubrium,  with 
which  it  makes  almost  a right  angle.  It  is 
articulated  in  a particular  groove  of  the  Os 
Tenlporis,  and  is  fixed  by  a ligamentous 
substance,  which  has  been  described  by 
anatomists  as  a muscle.  It  turns  in  this 
groove,  and  is,  in  a word,  a pivot,  on 
which  the  motions  of  the  Malleus  are  per- 
formed. 

The  second  bone  is  the  Incus.  It  may 
be  divided  into  the  body  and  two  crura. 

In  the  body  of  the  bone  is  the  irregular 
articular  surface,  by  which  it  is  so  firmly 
connected  with  the  Malleus,  as  to  be  almost 
immoveable. 


18 


The  two  Crura  are  of  unequal  lengths';' 
The  shorter  Crus  is  thicker  than  the  other, 
and  is  placed  almost  horizontally.  It  arti- 
culates in  a little  depression  near  the  aper- 
ture of  the  Mastoid  cells.  The  ligaments, 
which  retain  it  in  this  articulation,  allow  a 
considerable  degree  of  motion. 

The  longer  Crus  descends  from  the  body 
of  the  bone,  is  more  slender  than  the  other, 
and  bent  at  its  extremity  towards  the 
Stapes,  with  which  it  articulates  by  the 
intervention  of  the  Os  Orbiculare.  Its 
direction  in  the  Tympanum  is  parallel 
with  the  Manubrium  of  the  Malleus,  and 
consequently  with  the  Membrana  Ty  111- 
pan  i. 

The  third  bone,  the  Os  Orbiculare,  is 
very  small,  hardly  as  big  as  a Millet  seed. 
Although  named  the  Os  Orbiculare,  its 
figure  is  oval.  It  may  be  considered  as 
an  inter-articular  bone,  between  the  Incus 
and  Stapes,  connected  with  both,  but  more 
firmly  ivitli  the  former,  to  which  it  gene- 
rally adheres,  when  the  bones  are  separa- 
ted. 


19 


The  fourth  bone  is  the  Stapes.  It  consists 
of  a base  and  two  Crura,  that  coalesce  to 
form  the  head,  which  is  of  an  oval  figure. 
To  this  the  Os  Orbiculare  is  attached. 

The  two  Crura  are  bent,  and  that  which 
is  nearest  to  the  Mastoid  process  is  more 
incurvated  than  the  other.  They  are 
grooved  on  the  inside,  and  a Membrane 
occupying  the  area  of  the  Stapes  is  fixed  in 
the  grooves. 

The  base  of  the  Stapes  exactly  fits  the 
Fenestra  Ovata,  which  it  closes.  It  is  kept 
in  this  opening  by  the  membranous  lining 
of  the  Tympanum,  and  the  membrane  of 
the  Vestibule,  but  enjoys  a certain  degree 
of  motioii.  The  Stapes  passes  from  the 
extremity  of  the  Incus  to  the  Fenestra 
Ovata,  in  an  oblique  direction,  so  that  the 
base  is  a little  higher  than  its  head,  and  the 
sides  are  between  the  vertical  and  horizon- 
tal line. 

These  bones  are  articulated  with  each 
other  by  capsular  ligaments,  of  a degree  of 
tenuity  proportioned  to  their  minuteness. 


20 


They  are  covered  with  a fine  vascular 
membrane,  from  which  numerous  little 
vessels  proceed,  that  penetrate  their  sub- 
stance. They  are  the  nutritious  vessels  of 
the  bones,  and  the  membrane  may  be  con- 
sidered  as  their  Periosteum. 

The  mechanism  of  these  bones  is  regu- 
lated by  the  action  of  two  muscles,  the 
Tensor  Membranse  Tvmpani  and  the  Mus- 
culus  Stapedeus. 

The  Tensor  Membranse  Tvmpani  is 
contained  in  a small  bony  canal,  parallel 
with  the  Eustachian  Tube,  from  the  carti- 
lage of  which  its  fibres  are  derived.  These 
fibres  are  collected  into  a long  round 
muscle,  that  passes  through  this  canal  and 
enters  the  Tympanum  bv  a slender  round 
tendon.  The  tendon  issuing  through  a 
small  aperture,  at  an  obtuse  angle  to  the 
line  of  the  muscle,  is  gently  deflected  to- 
wards the  Manubrium  of  the  Malleus,  and 
is  inserted  into  its  upper  part; 

The  action  of  this  muscle  retracts  the 
tendon  into  the  aperture  of  the  bony  canal. 


By  this  the  Manubrium  of  the  Malleus  is 
drawn  inwards,  and  the  Membrana  Tym- 
pani,  which  is  attached  to  it,  put  upon  the 
stretch. 

A similar  effect  is  produced  on  the  mem* 
hi  •ane  of  the  Vestibule  by  the  contraction  of 
the  Musculus  Stapedeus,  the  fleshy  belly  of 
which  is  contained  in  a canal  of  bone  con- 
tiguous to  the  Stylo-mastoid  canal.  It  sends 
a small  round  tendon  through  an  aperture 
of  the  bone,  which  is  directed  obliquely  up- 
wards to  the  head  of  the  Stapes,  into  which 
it  is  inserted. 

What  remains  to  be  described  of  the 
middle  part  of  the  Ear  is  the  little  nerve  of 
the  Tympanum,  well  known  by  the  name  of 
the  Chorda  Tympani.  As  the  Portio  Dura 
of  the  Auditory  nerve  passes  through  the 
Stylomastoid  canal  between  the  Tympanum 
and  Mastoid  process,  it  detaches  a small 
branch  through  a particular  canal,  which 
opens  in  the  back  of  the  Tympanum,  near 
the  groove,  that  contains  the  Membrana 
Tympani. 


22 


The  Chorda  Tympani  traverses  the 
Tympanum,  lying  between  the  Manubrium 
of  the  Malleus  and  longer  Crus  of  the  Incus, 
and  enters  another  little  canal  nearly  op- 
posite to  the  former.  It  then  continues  its 
course  forwards  and  downwards  between 
the  Pterygoid  Muscles,  and  joins  the  Lin- 
gual branch  of  the  Inferior  Maxillary  nerve. 
This  extremity  of  the  Chorda  Tympani  is 
larger  than  that  which  is  joined  to  the 
Portio  Dura,  Avhence  some  have  considered 
it  as  a branch  of  the  Lingual  nerve.  It  is, 
in  a word,  a nerve  of  communication,  equally 
belongs  to  both,  and  is  connected  with  the 
trunk  of  each  at  an  acute  angle. 


23 


CHAPTER  III. 


A description  of  the  Internal  Fart  of  the  Ear} 
which  contains  the  expansion  of  the  Audi- 
tory Nerve,  and  may  therefore  he  considered 
the  Seat  of  Hearing. 

The  Internal  part  of  the  Ear,  which  I am 
now  about  to  describe,  has,  on  account  of 
the  intricacy  of  the  canals  and  cavities 
which  compose  it  been  generally  denomi- 
nated the  Labyrinth.  It  comprehends  the 
Vestibule,  semicircular  canals,  and  the 
Cochlea,  which  are  incased  in  the  Petrous 
portion  of  the  Os  Temporis. 

The  Vestibule  is  the  central  cavity,  and 
communicates  both  with  the  semicircular 
canals  and  the  Cochlea;  the  latter  lying 
in  the  extreme  point  of  the  Petrous  portion 
of  the  Os  Temporis,  the  former  towards 
the  Mastoid  cells.  The  shape  of  the  Ves- 
tibule is  irregularly  spherical.  However, 


24 


on  examination,  when  it  is  properly  laid 
open,  two  distinct  depressions  are  observa- 
ble, one  semi-elliptical,  and  situated  above, 
the  other  hemispherical,  and  situated  below. 
Both  are  opposite  to  the  Meatus  Internus, 
a canal  soon  to  be  described,  and  the  bony 
partition  is  thin  and  perforated  with  nume- 
rous small  holes  to  transmit  fibres  of  tlic 
Auditory  Nerve. 

In  the  prepared  bone,  the  Vestibule  is 
open  towards  the  Tympanum,  but  as  we 
have  already  seen,  the  Fenestra  Ovata  is,  in 
the  recent  state,  closed  by  the  base  of  the 
Stapes.  Six  other  apertures  present  them- 
selves in  the  Vestibule,  five  of  which  belong 
to  the  semi-circular  canals,  and  the  sixth 
is  the  beginning  of  one  of  the  Scalse  of  the' 
Cochlea. 

The  semicircular  canals,  although  uni- 
versally so  called,  are  all  larger  then  semi- 
circles. They  make  at  least  three-fourths 
of  a circle.  Their  calibre  is  small,  about 
the  size  of  a common  pin,  and  of  an  ellip- 
tical figure.  The  smallest  part  of  each 
canal  is  about  the  middle  of  its  curve.  They 


25 


enlarge  as  they  enter  the  Vestibule,  hut  one 
extremity  of  each  canal  is  particularly  dila- 
ted, and  is  called  Ampulla. 

The  semicircular  canals  are  three,  and 
are  distinguished  from  each  other  by  names 
given  them  from  their  position  or  direction. 
I shall  call  them  the  Vertical,  the  Oblique, 
and  the  Horizontal. 

The  Vertical  canal  describes  its  curve  in 
the  summit  of  the  Petrous  portion  of  the 
Os  Temporis,  and  crosses  it  with  its  convex 
side  above. 

The  Oblique,  an  the  contrary,  describes 
its  curve  in  the  occipital  side  of  the  Os 
Temporis,  and  its  convexity  is  placed  below. 

The  Horizontal  canal  is  bent  with  its 
convexity  towards  the  Mastoid  process, 
and  is  directly  above  a portion  of  the  Stylo- 
mastoid canal. 

The  three  semicircular  canals  enter  the 
Vestibule  only  by  five  apertures,  for  the 

F, 


26 


smaller  extremity  of  the  Vertical  canal  joins 
the  smaller  extremity  of  the  Oblique,  and 
their  orifice  is  common’. 

The  Cochlea  has  received  its  name  from 
its  resemblance  to  the  shell  of  a common 
snail.  The  resemblance  is  merely  external, 
and  is  only  discernible  in  the  Cochlea  of 
the  Foetus  during  the  first  months;  for  as 
ossification  advances,  the  bony  substance 
of  the  Cochlea  is  blended  with  the  rest  of 
the  Petrous  portion  of  the  Os  Temporis. 
However,  the  proper  substance  of  the 
Cochlea  may  be  discovered  even  in  the 
adult,  by  its  greater  brittleness  and  yellow 
colour. 

The  Cochlea  is  constructed  with  a Mo- 
diolus or  central  pillar,  on  which  a Spiral 
Tube  is  w ound,  and  a spiral  Lamina  w ound 
on  the  same  Modiolus,  lying  within  the 
Spiral  Tube  and  dividing  it  into  two.  Its 
figure  is  conical,  and  position  oblique.  It  is 
placed  in  the  anterior  part  of  the  Petrous 
portion  of  the  Os  Temporis,  contiguous  to 
the  canal  that  lodges  the  iuternal  Carotid 


27 


.Artery,  with  its  base  towards  the  Meatus 
Interims  and  the  apex,  which  is  lower  than 
the  base,  towards  the  Tympanum. 

To  facilitate  the  description  of  the  Coclr 
lea,  it  will  be  advisable  separately  to  consi- 
der the  three  parts  which  form  it,  that  is  to 
say,  the  Modiolis,  the  Spiral  Tube,  and  Spi- 
ral Lamina. 

The  Modiolus  commences  from  the  bot- 
tom of  the  Meatus  Internus  by  a concave 
plate,  perforated  with  numerous  Forami- 
nula,  the  extremities  of  small  bony  tubes 
that  freely  communicate  with  one  another, 
and  run  from  the  base  towards  the  apex. 

The  Modiolus  itself  consists  of  these  little 
bony  tubes,  blended  into  a mass  of  a coni- 
cal figure.  The  interior  fasciculi  of  tubes 
are  the  shortest,  and  they  lengthen  towards 
the  centre,  in  which  the  longest  and  largest, 
which  reaches  the  apex  of  the  Cochlea,  is 
placed.  They  terminate  on  the  sides  of 
the  Modiolus  at  different  distances.  At 
their  terminations  they  bend  at  right  angles 
towards  the  Spiral  Tube,  and  their  orifices 


28 


describe  about  the  Modiolus,  a spiral  tract, 
corresponding  with  the  tube  in  direction. 
In  proportion  as  they  terminate  the  Mo- 
diolus diminishes,  and  its  apex  is  exceeding- 
ly slender. 

The  Spiral  Tube  is  wound  on  the  Mo- 
diolus, and  adheres  to  its  sides.  As  it  runs 
towards  the  apex,  the  curve  which  it  makes 
is  constantly  diminishing.  It  makes  two 
turns  and  a half  from  the  base  to  the  apex, 
and  gradually  decreases  in  its  capacity. 

The  Spiral  Lamina  arises  from  the  Ves- 
tibule, and  u inds  round  the  Modiolus  tvith- 
in  the  Spiral  Tube.  Its  greatest  breadth  is 
at  its  origin,  whence  it  gradually  becomes 
narrower,  as  it  approaches  the  apex  of  the 
Cochlea.  Two  thin  plates  of  bone  com- 
pose it,  and  appear  to  unite  at  their  margin, 
from  which  a membranous  substance,  which 
is  reflected  on  each  side,  proceeds. 

The  Spiral  Lamina  w ith  the  aid  of  this 
Membrane,  makes  a complete  septum,  and 
divides  ti  e Spiral  Tube  into  two  canals, 
one  of  which  is  called  the  Scala  Tympani. 


29 


from  its  Laving  an  aspect  towards  the  Tym- 
panum, the  other  the  Scala  Vestibuli,  from 
its  arising  in  the  Vestibule. 

The  Scala  Tympani  is  nearest  the  base 
of  the  Cochlea,  and  begins  from  the  Fenes- 
tra Rotunda,  but  is  prevented  from  com- 
municating with  the  Tympanum  by  the 
Membrane  which  closes  this  aperture. 

The  Scala  Vestibuli  begins  by  an  oval 
orifice  between  the  Fenestra  Ovata  and  the 
Ampulla  of  the  Vertical  canal. 

The  two  Scalse  run  parallel  with  each 
other,  but  have  no  communication  except 
at  the  apex  of  the  Cochlea. 

When  the  Cochlea  is  cut  obliquely  from 
the  base  to  the  apex  at  a proper  distance  from 
the  Modiolus,  the  section  exhibits  the  ap- 
pearance of  three  successive  compartments, 
each  containing  a portion  of  the  septum  of 
the  Scalse.  The  half  turn  of  the  septum 
occupies  the  last  compartment,  and  as  it 
joins  the  extremity  of  the  Spiral  Tube,  a 


30 


little  hole  is  left.  This  is  the  hole  by  which 
the  Sealse  communicate. 

To  obtain  a view  of  this  aperture  of  com- 
munication, it  is  necessary  to  preserve  the 
membranous  part  of  the  septum,  for  the 
Spiral  Lamina  itself  does  not  reach  the 
extremity  of  the  Spiral  Tube.  This  may 
be  ascertained  by  examination  of  the  ma- 
cerated Cochlea,  in  which,  when  a similar 
section  is  made,  the  extreme  point  of  the 
Spiral  Lamina  may  be  perceived  just  rising 
into  the  last  compartment  and  perfectly 
detached;  but  in  the  recent  state,  the 
Membrane,  which  goes  off  from  the  Spiral 
Lamina  to  complete  the  septum,  passes 
also  from  its  point  to  the  extremity  of  the 
Spiral  tube,  where  it  is  so  attached,  as  to 
leave  the  little  hole  already  mentioned. 

In  the  occipital  side  of  the  Os  Temporis, 
contiguous  to  the  Vestibule  and  Cochlea, 
is  the  canal  through  which  the  Auditory 
Nerve  passes.  It  is  named  Meatus  Inter- 
nus,  is  oval,  and  about  the  third  of  an  inch 
in  length.  The  extremity  towards  the 


31 


labyrinth  is  closed  except  at  the  upper 
part,  where  a small  foramen,  which  is  the 
beginning  of  the  Stylo-mastoid  canal,  ap- 
pears. 

Immediately  below  this  foramen,  two 
cribriform  plates  are  placed,  the  upper  op- 
posite to  a portion  of  the  semi-elliptical 
cavity  of  the  Vestibule,  the  lower  to  the 
hemispherical. 

A little  lower,  and  separated  by  a slight 
ridge,  a cribriform  sulcus  is  continued  to  a 
round  concave  cribriform  plate,  the  base  of 
the  Modiolus  of  the  Cochlea. 

The  Vestibule,  semicircular  Canals,  and 
the  Cochlea,  are  lined  with  a delicate  Pe- 
riosteum. They  contain  also  a membra- 
nous texture,  formed  into  sacs  and  tubes, 
and  filled  with  a transparent  fluid,  similar 
to  the  aqueous  humour  of  the  Eye. 

The  membranous  sacs  and  tubes  are 
smaller  than  the  osseous  cavities  which 
contain  them,  but  exactly  correspond  in 
shape.  They  adhere  very  slightly  to  the 


S2 


Periosteum  of  the  osseous  cavities  by  an 
exceedingly  fine  cellular  membrane. 

The  Vestibule  contains  two  membranous 
sacs,  one  seated  in  the  hemispherical  de- 
pression, the  other  in  the  semi-elliptical. 
I shall  call  them  by  the  names  of  the  de- 
pressions, in  which  they  are  lodged. 

The  semi-elliptical  sac  is  larger  than  the 
hemispherical,  and  is  that  in  which  the 
membranous  semicircular  canals  and  Scala 
Vestibuli  centre.  Although  the  cavities  of 
these  sacs  are  distinct,  the  sacs  themselves 
cannot  be  separated,  because  theire  sides 
are  in  contact  with  each  other,  adhere,  and 
are  too  delicate  to  admit  of  division  by  dis- 
section. 

The  membranous  semicircular  canals 
exactly  resemble  the  osseous  tubes  in 
which  they  are  placed,  and,  therefore,  re- 
quire no  farther  description.  They  open 
in  the  semi-elliptical  sac. 

The  Membranous  Tubes  of  the  Cochlea 
correspond  with  the  Scalse.  One  arises 


33 


from  the  semi-elliptical  sac  of  the  Vestibule, 
the  other  from  the  membrane  of  the  Fenes- 
tra Rotunda,  to  which  it  adheres.  They 
communicate,  as  the  two  Scalse  do,  in  the 
apex  of  the  Cochlea. 

The  fluid  contained  in  the  cavities  of 
these  membranes  is  secreted  by  their  inte- 
rior surface,  in  the  same  manner  as  the 
Liquor  Pericardii  is  secreted  by  the  Peri- 
cardium. A considerable  degree  of  vascu- 
larity seems  the  necessary  consequence  of 
their  secretory  functions.  The  vessels  which 
supply  them,  pass  from  the  Periosteum  in 
a serpentine  direction,  and  so  far  are  easily 
discovered;  but  when  dispersed  on  the  pe- 
culiar structure  of  the  Membranes,  tliev 
are  too  minute  to  admit  the  red  globules  of 
the  blood. 

The  Membranous  Texture,  just  described, 
is  destined  to  receive  the  ultimate  distribu- 
tion of  the  Auditory  nerve  or  Portio  Mollis 
of  the  seventh  pair.  It  arises  from  the  Tu~ 
berculum  Annulare  in  the  Ventricle  of  the 
Cerebellum,  and  the  Crus  Cerebelli.  As  it 
turns  round  the  Medulla  Oblongata,  it  is 

F 


joined  by  the  Portio  Dura,  which  it  partially 
receives  in  a species  of  groove,  and  both 
enter  the  Meatus  Internus,  being  connected 
by  a fine  cellular  membrane. 

The  Portio  Dura  quits  the  Portio  3Iollis 
at  the  bottom  of  the  Meatus  Internus,  and 
continues  its  course  through  the  Stylo- 
mastoid canal,  and  is  no  otherwise  con- 
nected with  the  Organ  of  Hearing,  than  as 
it  receives  the  Chorda  Tympani. 

The  Portio  Mollis  consists  of  two  Fasci- 
culi nearly  of  equal  size,  one  of  which  sup- 
plies the  Vestibule  and  semicircular  canals, 
the  other  the  Cochlea. 

The  nerve  of  the  Vestibule  and  semicir- 
cular canals  subdivides  into  three  branches 
after  forming  a gangliform  swelling.  The 
largest  branch  sends  its  fibrils  through  the 
cribriform  plate  opposite  to  the  semi-ellip- 
tical sac  of  the  Vestibule.  They  pass  in  a 
distinct  plexus  upon  the  Sac,  and  are  lost 
in  a pulpy  substance,  which  vanishes  in  the 
Ampulla  of  the  Vertical  and  Horizontal 
membranous  canals. 


35 


The  second  branch  passing  through  the 
inferior  cribriform  plate  is  dispersed  in  a 
similar  substance  on  the  Hemispherical  sac. 

The  last  branch  also  passes  through  a 
small  cribriform  plate,  and  is  lost  on  the  Am- 
pulla of  the  Oblique  membranous  canal. 

The  Fasciculus  of  the  Cochlea  is  twisted, 
an  appearance  which  arises  from  the  mode 
in  which  its  fibres  enter  the  Modiolus.  As 
they  pass  through  its  substance,  they  form 
plexuses  through  the  communicating  holes 
of  the  bony  tubes.  Some  of  the  fibres  issue 
from  the  Modiolus  through  the'Foraminula 
of  the  Spiral  Lamina,  but  the  greater  num- 
ber and  the  largest  issue  through  the  Fora- 
miimla,  between  the  Spiral  Lamina,  and 
the  junction  of  the  Spiral  tube  to  the  Mo- 
diolus. 

As  the  nerve  detaches  its  fibres  along  the 
spiral  tract  of  the  Foraminula,  it  lessens 
towards  the  apex,  as  the  Modiolus  itself 
does,  but  its  central  filament  passes  straight 
through  the  central  foramen  of  the  Modi- 


36 


olus,  and  ramifies  on  the  half  turn  of  the 
Spiral  Lamina. 

The  fibrillse  of  the  nerve  may  be  dis- 
tinctly seen  as  they  enter  the  Scalae  of  the 
Cochlea,  making  a distinct  plexus  on  the 
Spiral  Lamina  in  the  edge  of  which  a per- 
fect network  is  formed.  This  network  ap- 
pears to  be  continued  in  a semi-pellucid 
pulpy  substance,  which  goes  from  the  edge 
of  the  spiral  Lamina  on  the  membranes  of 
the  Scalffi,  and  is  said  to  resemble  the  Re- 
tina; but  a structure,  so  minute  and  intri- 
cate as  this,  must  for  ever  elude  perfect 
investigation. 


37 


The  causes  of  Loss  or  Imperfection  of 
Hearing  are  very  numerous,  as  may  easily 
be  conceived  by  those  who  have  contem- 
plated the  complexity  of  the  Ear.  They 
are  involved  in  the  greatest  obscurity,  and 
I am  fully  sensible  that  all  which  I shall 
offer  on  this  subject  is  to  be  considered 
only  in  the  light  of  an  Essay. 

Few  attempts  have  hitherto  been  made 
by  Anatomists  to  investigate  the  morbid 
changes  to  which  the  Ear  is  liable.  On 
this  head  we  are  almost  destitute  of  infor- 
mation, at  a period  when  by  their  labours 
the  diseases  of  the  other  Organs  of  the 
body  have  been  ascertained,  and  the  symp- 
toms which  accompany  them  recorded. 
.But  our  Ignorance  will  soon  cease  to  be 


38 


the  cause  of  astonishment,  if  we  reflect  on 
the  obstacles  which  oppose  our  inquiries. 
These  are  almost  insuperable.  Nature  has 
placed  the  greater  part  of  the  Ear  in  a situ- 
ation absolutely  beyond  the  reach  of  ex- 
amination in  the  living  body,  and  as  its 
diseases  are  rarely,  if  ever,  mortal,  morbid 
Ears  are  seldom  dissected  in  the  dead. 
Such  observations  as  are  related  have  most- 
ly been  made  on  subjects  that  have  casu- 
ally fallen  into  the  hands  of  the  Dissector, 
and  the  history  of  the  cases  is  unknown. 

But  it  would  not  suffice  if  Anatomy  were 
able  to  develope  every  morbid  alteration 
of  structure  of  which  this  Organ  is  suscept- 
ible. A great  object  would  indeed  be 
gained,  but  a greater  would  still  remain 
unaccomplished.  Before  the  mind  of  the 
practitioner  can  be  directed  to  any  de- 
terminate object;  a history  of  symptoms 
must  be  annexed  to  each  specific  change, 
and  these  symptoms  must  be  sufficiently 
distinct.  This  demands  a multitude  of 
dissections  and  a series  of  attentive  obser- 
vations. A clear  and  distinct  recital  of 
symptoms  is  rarely  obtained  from  the  deaf. 


39 


They  are  conscious  of  their  infirmity,  but 
very  few  are  impressed  with  a notion  that 
Hearing  may  he  impaired  by  a variety  of 
causes.  The  approach  of  Deafness  is  insi- 
dious and  often  unattended  with  pain.  Few 
strong  impressions  are  made  on  the  mind 
of  the  patient,  and  he  loses  his  faculty  of 
hearing  so  imperceptibly,  that  in  general  his 
friends  sooner  discover  his  misfortune  than 
himself. 

Here  then  the  labour  and  the  difficulty 
commence;  but  the  field  is  open.  Anato- 
mists have,  to  the  present  da}r,  avoided  this 
subject,  some  doubtless  convinced  of  the 
impracticability,  and  others  disgusted  at 
the  difficulty  of  the  enquiry.  As  Anatomists 
have  neglected  the  investigation  of  these 
diseases,  so  practitioners  have  either  aban- 
doned such  patients  to  Quacks,  or  consign- 
ed them  to  the  care  of  Providence. 

But  although  I admit  the  difficulty  in  all 
instances,  and  in  many  our  total  inability  to 
obtain  an  adequate  knowledge,  yet  X must 
differ  from  those  who  think  that  such  cases 
should  be  abandoned.  I am  convinced  that 


40 


the  subject  may  be  very  much  elucidated, 
if  many  individuals,  having  great  opportu- 
nities of  examining  dead  bodies,  and  ani- 
mated with  proper  zeal  in  the  inquiry, 
would  employ  some  portion  of  their  time 
in  the  dissection  of  such  diseased  Ears  as 
chance  may  subject  to  their  inspection. 
By  this  proceeding  many  facts  respecting 
defects  or  diseased  changes  of  structure  in 
the  Ear  may  soon  be  obtained.  In  many 
instances,  where  a previous  acquaintance 
with  the  patient  affords  the  opportunity, 
the  attendant  symptoms  may  he  ascertain- 
ed. Thus  the  observer,  combining  in  one 
view  the  cause  and  effect,  may  be  capable 
in  many  instances  of  inventing  means  of 
relief. 

But  it  must  be  admitted  that  such  perfect 
researches  into  the  cause  and  seat  of  the 
diseases  of  the  Ear,  however  they  may  en- 
large our  knowledge,  will  not  in  an  equal 
degree  augment  our  ability  to  remedy 
them.  The  maladies  of  the  interior  parts 
of  the  Ear  constitute  a very  numerous  class, 
amounting;  at  least  to  one  third  of  the 
causes  of  deafness.  As  these  are  seated  in 


41 


the  Labyrinth,  a part  of  the  Ear  inacces- 
sible in  the  living  subject,  operative  Sur- 
gery is  excluded  from  all  chance  of  reliev- 
ing them. 

The  impossibility  of  curing  the  defects 
of  the  Internal  part  of  the  Ear  by  manual 
operations  is  therefore  manifest,  but  it  by 
no  means  follows  that  such  cases  are  irre- 
mediable. Many  morbid  changes  of  the 
vital  organs  of  the  body,  equally  inscrut- 
able as  the  Ear,  in  the  living  subject,  are, 
when  we  know  the  symptoms  indicating 
their  existance,  successfully  treated  by  the 
operation  of  internal  remedies:  and  I have 
no  doubt  that  deafness  in  various  instances 
depends  on  morbific  changes  which  are 
curable  by  the  general  treatment  of  the 
constitution.  I trust  I shall  he  able  to 
prove,  in  the  course  of  the  following  pages, 
that  the  assemblage  of  symptoms  which 
practitioners,  for  want  of  a more  appropri- 
ate term,  have  conspired  to  call  Nervous 
Deafness,  not  only  admits  of  relief,  but  may 
be  completely  cured  in  the  incipient  state. 

i 

These  preliminary  observations  have  been 
6 


42 


made  purposely  to  display  to  tlie  reader 
the  difficulty  of  treating  successfully  many 
of  the  diseases  of  the  Ear,  and  not  with  a 
view  to  discourage  him  from  the  attempt. 
I know  the  character  of  the  profession  too 
well  to  suppose  that  its  members  can  be 
deterred  by  difficulties,  or  that  there  are 
not  many  who  would  think  no  time  mis- 
spent, that  is  employed  in  endeavours  to 
heal  the  infirmities  of  the  species. 

I have  necessarily  exhibited  the  dark 
side  of  the  picture,  as  my  intention  in 
making  these  reflections  has  been  directed 
to  the  most  abstruse  and  inscrutable  dis- 
eases of  the  organ.  The  prospect  will 
brighten  as  wo  enter  more  into  the  detail. 
We  shall  then  find  that  some  are  very  sim- 
ple, and  attended  with  too  little  difficulty 
in  practice,  to  be  introduced  in  the  general 
outline. 

Of  those  too  which  occupy  the  more  com- 
plicated parts,  all  are  not  equally  unknown 
and  remediless.  Mr.  Cooper  has  proposed 
and  executed  the  happy  and  successful  ex- 
pedient of  perforating  the  Membrana  Tym- 


43 


pani,  in  that  species  of  deafness  which  an 
obstructed  Eustachian  Tube  produces. 

It  has  been  my  humble  endeavour  to  in- 
vestigate another  disease  of  the  Tympa- 
num, the  puriform  discharge,  to  ascertain 
its  origin  and  progressive  stages,  and  to 
point  out  a proper  mode  of  treatment. 


OF  THE  DISEASES  OF  THE  MEA- 
TUS EXTEENUS. 

Tut  diseases  which  attack  the  Meatus 
Externus  are  the  most  simple  to  which  the 
Ear  is  liable.  They  admit  of  examination 
by  inspection  and  the  touch,  and  are  there- 
fore generally  well  understood. 

The  Meatus  Externus  is  subject  to  in- 
flammation. An  inflammation  of  this  part 
in  consequence  of  the  hard  and  unyielding 
materials  which  compose  it,  is  accompanied 
with  the  most  acute  pain,  and  a great  de- 
gree of  general  excitement.  Its  cure  should 


44 


be  attempted  by  resolution.  It  is  enough 
to  say  that  the  most  active  antiphlogistic- 
plan  is  necessary  to  accomplish  this  inten- 
tion. 

When  the  means  employed  to  reduce 
the  inflammation  have  not  succeeded,  and 
matter  has  formed,  it  is  generally  evacuat- 
ed, as  far  as  I have  observed,  between  the 
Auricle  and  Mastoid  process,  or  into  the 
Meatus.  If  it  has  been  evacuated  into  the 
Meatus,  the  opening  is  most  commonly 
small,  and  the  spongy  granulations,  squeez- 
ed through  a small  aperture,  assume  the 
appearance  of  a Polypus.  Sometimes  the 
small  aperture  by  which  the  matter  is  eva- 
cuated, is  in  this  manner  even  closed 
and  the  patient  suffers  the  inconvenience 
of  frequent  returns  of  pain  from  the  reten- 
tion of  the  discharge.  When  the  parts 
have  fallen  into  this  state,  it  will  be  expe- 
dient to  hasten  the  cure  by  making  an  in- 
cision into  the  sinus  between  the  Auricle 
and  Mastoid  process. 

It  occasionally  happens  that  the  bone 
itself  dies,  in  consequence  of  the  sinus 


45 


being  neglected,  or  the  orginal  extent  of 
tbe  suppuration.  The  exfoliating  parts  are 
tbe  Meatus  Externals  of  tlie  Os  Temporis? 
or  tbe  external  lamina  of  tbe  Mastoid  pro- 
cess. 

A short  time  ago  I was  consulted  by  a 
patient,  according  to  whose  account,  and 
as  far  as  I could  judge  from  the  examina- 
tion of  parts  that  were  healed,  the  whole 
Meatus  Externus  must  have  exfoliated; 
and  I saw  a child  a few  weeks  ago,  in 
w hom  the  outer  part  of  the  Mastoid  process 
was  in  a state  of  exfoliation. 

The  Meatus  Externus  and  Auricle  are 
sometimes  affected  with  an  herpetic  ulcer- 
ous eruption.  It  always  produces  a great 
thickening  of  the  integuments,  and  the 
passage  is  often  so  much  closed  that  a great 
degree  of  deafness  ensues.  The  ichor 
which  exudes  from  the  pores  of  the  ulcer- 
ated surface,  inspissates  in  the  Meatus,  and 
not  only  obstructs  the  entrance  of  sound, 
but  is  accompanied  with  a great  degree  of 
fetor.  This  disease  is  not  unfrequent.  I 
have  never  seen  it  resist  the  effect  of  alter- 


46 


alive  medicines,  and  tlie  use  of  the  appli- 
cations employed  in  the  following  cases. 

CASE  I. 

Miss  S.  E.  applied  for  a complaint  in  her 
Ear,  that  had  for  many  months  greatly 
diminished  the  power  of  hearing.  It  proved 
on  examination  to  he  an  Herpetic  ulcera- 
tion of  the  Meatus  Externus  and  Auricle. 
The  orifice  of  the  Meatus  was  almost  closed. 
With  difficulty  I introduced  the  nozzle  of 
a syringe,  and  brought  out  a considerable 
quantity  of  inspissated  discharge.  The 
oozing  of  the  ichor  was  very  great. 

She  was  perfectly  cured  at  the  end  of 
two  months  by  taking  two  grains  of  Calo- 
mel every  day;  and  the  injection  of  a lo- 
tion of  Hydrargyrus  Muriatus  cum  Aqua 
Calcis,  and  the  application  of  the  Unguen- 
tum  Hydrargyri  Nitrati. 

CASE  II. 

Mr.  R.  W.  applied  with  similar  symp- 
toms, only  in  an  inferior  degree.  He  had 


47 


laboured  under  the  complaint  above  a 
twelvemonth.  His  defect  of  hearing  dur- 
ing this  time  had  varied  greatly,  accord- 
ing, as  I suppose,  to  the  degree  of  thick- 
ening in  the  parts,  or  the  inspissation  of  the 
discharge. 

He  was  cured  by  a similar  treatment  in 
the  course  of  three  weeks. 

Miss  C.  IV.  A similar  case.  The  disease 
had  existed  in  different  degrees  of  force  for 
several  months. 

She  was  cured  at  the  end  of  a month  by 
the  exhibition  of  Calomel,  and  the  injection 
of  a solution  of  Argentum  Nitratum. 

The  lining  of  the  Meatus  Externus,  like 
that  of  the  nostrils,  is  capable  of  producing 
excrescences.  They  are  generally  termed 
Polypi.  Such  as  have  fallen  under  my  in- 
spection more  nearly  resemble  syphilitic 
warts,  and  appear  to  be  produced  in  a si- 
milar manner,  viz.  by  irritation.  I have 
never  observed  these  excrescences  in  the 
Meatus  Externus,  when  the  Tympanum  is 


48 


sound.  But  a purulent  discharge  from  the 
Tympanum  is  complicated  with  the  form- 
ation of  Funguses  and  Polypi,  as  will  he 
seen  in  the  proper  place.  However,  I do 
not  mean  to  deny  the  existence  of  these 
excrescences  when  the  other  parts  of  the 
organ  are  sound.  I am  certain  they  are 
very  rare,  but  when  they  do  arise,  are 
easily  treated.  They  should  be  extracted 
with  Forceps,  and  the  part  from  which 
they  are  torn,  touched  with  caustic,  intro- 
duced with  proper  caution,  that  it  may 
not  extend  to  the  Membrana  Tympani. 

The  passage  of  the  Meatus  Externus  has 
occasionally  been  obstructed  by  an  unna- 
tural septum,  originating  from  an  elonga- 
tion or  diseased  growth  of  the  Cutis.  As 
we  have  been  informed,  this  was  the  state 
of  the  Meatus  in  a case  where  the  Mem- 
brana Tympani  was  perfect,  and  Hearing 
was  restored  by  a laceration  of  the  parti- 
tion. Tide  Mons.  Maunoir’s  communica- 
tion in  the  Medical  Journal  for  1S00. 

I believe  these  cases  are  rare,  unless  the 
Tympanum  be  diseased,  but  are  not  unfre- 


49 


quent  after  a suppuration  and  puriform 
discharge.  The  following  is  an  instance 
of  its  having  formed  after  a puriform  dis- 
charge. 

I.  Hallam  applied  at  the  Dispensary  for 
a very  considerable  and  sudden  increase  of 
a deafness,  with  which  he  had  been  many 
years  afflicted.  The  deafness  had  originally 
been  produced  by  a suppuration  of  the 
Tympanum,  and  he  recollected,  that  during 
the  discharge,  air  had  occasionally  passed 
through  the  Meatus  in  the  act  of  blowing 
his  nose.  The  discharge  had  ceased  to  flow 
outwardly,  and  he  was  no  longer  capable 
of  forcing  air  through  the  Meatus.  He 
now  spoke  of  a particular  sensation,  similar 
to  what  people  experience  when  they  inflate 
the  Tympanum.  By  placing  the  patient 
in  the  light  of  the  sun,  I perceived  a septum, 
which  I pierced  and  lacerated,  after  which 
the  patient  could  perceive  at  nine  inches, 
the  tick  of  a watch,  which  he  was  before 
obliged  to  place  in  contact  with  his  Ear. 
Some  difficulty  arose  to  prevent  the  reunion 
of  parts.  It  was  at  last  accomplished,  and 

the  patient’s  hearing  improved  to  the 

n 


50 


degree  in  which  it  is  usually  possessed  by 
those  who  have  lost  the  Membrana  Tym- 
pani. 

But  the  most  common  impediment  to 
hearing,  that  depends  on  the  state  of  the 
Meatus  Externus,  arises  from  the  inspissa- 
tion  of  the  Cerumen.  The  quantity  which 
may  be  collected  without  impairing  the 
power  of  hearing,  cannot  easily  be  deter- 
mined.  In  many  persons  the  quantity  is 
naturally  considerable.  But  unless  its 
proper  consistence  be  altered,  the  functions 
of  the  passage  are  not  much  injured, 
whereas  a small  portion  of  hard  Cerumen, 
lodged  on  the  Membrana  Tympani,  will 
deprive  a person  of  his  hearing. 

The  symptoms,  which  are  attached  to 
the  inspissalion  of  the  Cerumen,  are  pretty 
well  known.  The  patient,  besides  his 
inability  to  hear,  complains  of  noises, 
particularly  a clash  or  confused  sound  in 
mastication,  and  of  heavy  sounds  like  the 
ponderous  strokes  of  a hammer. 

The  practitioner  is  led  by  the  relation  of 


51 


such  symptoms  to  suspect  the  existence  of 
wax;  but  he  may  reduce  it  to  a certainty 
by  examination. 

Any  means  capable  of  removing  the 
inspissated  wax,  may  be  adopted,  but 
syringing  the  Meatus  with  warm  water  is 
the  most  speedy  and  effectual,  and  the  only 
means  necessary.  As  the  organ  is  sound, 
the  patient  is  instantaneously  restored  by 
its  removal.  A little  pleasant  distress  arises 
from  the  violent  excitement  produced  in  the 
Ear,  as  soon  as  it  is  acted  upon  in  this  state 
of  accumulated  sensibility,  by  its  accustom- 
ed stimulus;  “ but  this  soon  ceases,  without 
leaving  any  unpleasant  effect.  This  disease, 
however  simple,  has  been  often  mistaken  or 
overlooked  and  the  cause  supposed  to  lie 
deep  in  the  structure  of  the  organ,  whilst  in 
fact,  it  arose  merely  from  the  source  above 
pointed  out;  which  show  s the  necessity,  in  all 
cases  of  deafness,  of  ascertaining,  by  an  ac- 
curate examination,  w hether  such  a mecha- 
nical cause  does  exist.” 

“ From  its  situation  the  external  passage  is 
subject  to  occasional  accidents,  or  other  me- 


52 


chanical  causes  than  inspissated  Cerumen 
acting  upon  it.” 

“ Thus,  in  cases  of  children,  small  bodies 
as  peas,  cherry-stones,  pins,  §c.  have  got  in- 
to the  Ear,  where,  exciting  inflammation,  they 
often  occasion  considerable  pain  before  they 
are  removed.  A number  of  remarkable  ca- 
ses of  such  accidents  will  be  found  related 
by  authors,  and  one  in  particular,  related  by 
Wildanus,  where  a bead  or  ball  of  glass 
lodged  in  the  passage  and  produced  deli- 
rium.” 

“ The  great  art  in  extracting  them,  is  to  be 
cautious  not  to  push  them  deeper;  they  are 
best  taken  out  with  a pair  of  small  forceps: 
and  a little  oil  may  he  dropped  into  the  ear  be- 
fore making  the  attempt.” 

“ In  the  same  way,  insects  at  times  get  into 
the  Ear,  which  produce  the  most  unpleasant 
feeling  in  the  part,  as  well  as  great  noise, 
and  often  actual  pain;  the  best  way  of  re- 
moving them  is  to  drown  them,  by  filling  the 
passage  with  mild  fluids,  as  water  or  oil,  by 
means  of  a syringe,  and  thus  washing  them 


53 


out.  Acrid  liquors  are  improper;  for,  in  the 
endeavour  to  avoid  tliem,  the  insect  gets 
deeper.  The  motion  is  often  so  severely 
felt  by  children,  as  to  produce  a state  little 
short  of  delirium;  after  the  removal,  a little 
oil  of  sweet  almonds  is  the  best  application, 
to  soothe  the  irritated  part.  Even  a little 
oil,  in  the  first  instance,  will  destroy  the 
insect.” 


OF  THE  DISEASES  OF  THE 
TYMPANUM. 

The  first  disease  of  the  middle  part  of  the 
Ear,  which  I shall  endeavour  to  investigate, 
is  the  puriform  discharge  from  the  Tympa- 
num. The  discharge  is  ichorous,  some- 
times tinged  with  blood,  and  imparts  a 
yellow  colour  to  a silver  instrument.  This 
disease  is  attended  with  a loss  of  hearing 
proportionate  to  the  injury  which  the 
machinery  of  the  Tympanum  has  sustained, 
and  the  sense  is  variously  impaired  from 
the  slightest  degree  up  to  total  deafness. 


54 


In  general,  when  the  patient  blows 
strongly  with  the  nose  and  mouth  closed, 
air  will  be  expelled  at  the  Meatus  Externus. 
Whenever  this  circumstance  is  observed,  it 
is  clear  that  the  discharge  proceeds  from,  or 
is  connected  with  an  injury  or  destruction 
of  the  Membrana  Tympani.  But  the  re- 
verse by  no  means  proves  that  the  Mem- 
brana Tympani  is  sound,  and  the  discharge 
therefore  confined  to  the  Meatus.  It  often 
occurs  that  the  same  inflammation,  which 
terminates  in  a suppuration  of  the  Tympa- 
num, previously  obliterates  the  Eustachian 
Tube,  which  remains  permanently  closed 
after  the  cessation  of  the  inflammation 
which  occasioned  it.  1 have  ascertained 
this  fact  by  dissection,  and  I possess  a pre- 
paration taken  from  a subject  in  whom  a 
puriform  discharge  from  the  Tympanum 
had  ceased.  In  this  person  half  the  mem- 
brana Tympani  had  been  destroyed,  but  the 
remnant  had  healed,  and  the  Eustachian 
Tube  was  impervious. 

Although,  air  cannot  he  made  to  issue  at 
the  Meatus  Externus,  we  are  not  therefore 


55 


authorized  to  - draw  the  conclusion,  that  the 
Membrana  Tympani  is  sound.  It  probably 
is  so,  but  it  must  be  ascertained  by  actual 
examination.  The  Ear  must  be  inspected 
in  a strong  light.  For  this  purpose  the 
patient  should  be  set  in  such  a position  that 
the  rays  of  the  Sun  may  fall  into  the  Meatus, 
and  illuminate  it  sufficiently  to  make  the 
bottom  risible;  or  the  Ear  may  be  sounded 
with  a blunt  probe,  and  any  person  ac- 
quainted with  the  particular  feel  of  the 
Membrana  Tympani,  may  easily  distinguish 
it  by  the  touch.  If  the  membrane  be 
defective,  the  instrument  will  pass  iuto  the 
Tympanum,  the  bony  superficies  of  which 
is  still  more  readily  distinguishable. 

He  therefore,  who  will  institute  a proper 
examination,  cannot  fail  of  arriving  at  a 
certain  knowledge  of  this  disease,  and  will 
not  confound  it  with  the  Herpetic  ulcerous 
state  of  the  Meatus  Externus.  In  the  latter, 
success  is  certain,  and  as  soon  as  the  ulcera- 
tion is  cured,  hearing  is  perfectly  restored: 
in  the  former,  however  perfectly  the  dis- 
charge may  be  suppressed,  the  event  is  very 
dubious.  It  is  therefore  a point  on  which 


56 


a practitioner,  who  wishes  to  determine  a 
priore  what  benefit  can  be  rendered  in  anv 
given  case,  cannot  be  indifferent. 

This  state  of  the  Tympanum  is  produced 
by  various  causes.  In  the  Scarlatina  Ma- 
ligna, inflammation  of  the  Tympanum 
attacks  the  patient,  and  advances  to  Gan- 
grene. If  he  survives  the  fever,  the  machi- 
nery of  the  Tympanum  often  sloughs  so 
extensively,  that  the  membrana  Tympani 
and  whole  chain  of  bones  is  evacuated,  and 
the  patient  is  perfectly  deaf. 

Most  commonly  this  disease  succeeds  the 
Ear-ache,  which  is  in  fact  an  acute  inflam- 
mation of  the  Tympanum.  If  the  inflam- 
mation should  not  subside  spontaneously,  or 
be  assuaged  by  art,  the  Tympanum  and 
Mastoid  cells  form  a large  quantity  of  pus. 
After  the  patient  has  suffered  the  most 
intense  pain,  the  Membrana  Tympani  ul- 
cerates, and  the  pus  is  discharged  at  once 
in  a large  quantity.  He  is  then  greatly  re- 
lieved, but  the  disease  ceases  not,  the  parts 
supply  fresh  matter,  whicli  continually 
oozes  at  the  Meatus. 


57 


The  symptoms  produced  by  inflammation 
of  the  Tympanum,  are  most  intense  pain 
in  the  Ear  and  Head,  a great  degree  of 
symptomatic  fever,  and  sometimes  slight 
delirium.  The  pain  fluctuates,  and  its 
paroxisms  resemble  the  Tooth-ache.  This 
resemblance  has  unfortunately  caused  it  to 
be  wholly  neglected,  or  very  improperly 
treated.  The  case  obviously  requires  the 
most  active  antiphlogistic  treatment,  and 
the  absence  of  every  thing  stimulative. 
But  the  opposite  system  prevails.  The 
most  acrid  applications  and  spirituous  li- 
quors are  the  general  means  employed  for 
the  relief  of  the  patient,  an  error  that  un- 
questionably tends  to  produce  the  worst 
catastrophe  which  can  happen,  viz.  the 
suppuration  of  the  parts. 

What  part  the  practitioner  ought  to  take 
on  the  attack  of  this  inflammation,  is  quite 
manifest.  If  he  should  be  consulted  suffi- 
ciently early,  it  will  most  probably  be  in  his 
power  to  stop  the  inflammation.  Then  all 
the  symptoms  subside.  The  deafness,  which 
is  very  great  during  the  paroxism,  will 


i 


58 


gradually  lessen,  as  the  deposited  lymph, 
its  necessary  effect,  is  absorbed. 

Not  always,  however,  will  the  patient 
recover  his  perfect  hearing,  even  when  the 
inflammation  has  terminated  in  resolution. 
But  as  I am  now  speaking  from  observation 
on  cases  abandoned  to  the  natural  process, 
I am  incapable  of  deciding  how  far  proper 
treatment  immediately  subsequent  to  the 
paroxism  can  obviate  the  defect  which  the 
inflammatory  state  has  left.  Few  will 
doubt  the  efficacy  of  such  remedies  as  pro- 
mote absorption.  If  in  parts  which  are 
visible,  we  have  ascertained  that  large  quan- 
tities of  lymph  are  absorbed  before  the 
completion  of  its  organization,  what  reason 
have  we  to  doubt  that  the  same  tiling  is 
accomplished  in  parts  similarly  affected 
which  are  not  visible?  We  cannot  resist  the 
conclusion,  that  the  Deafness  which  remains 
after  an  inflammation  of  the  Tympanum  is 
not  an  inevitable  consequence,  but  arises 
from  neglect,  and  allowing  the  deposited 
lymph  to  become  organized;  and  if  the 
lining  of  the  Tympanum  remain  perma- 
nently thickened,  or  organized  adhesions  be 


59 


formed,  about  the  chain  of  bones,  a certain 
defect  must  be  the  result. 

But  let  it  be  admitted,  that  the  Tympa- 
num lias  suppurated.  Ought  the  Membrana 
Tympani  to  be  abandoned  to  a casual 
ulceration,  or  is  it  better  to  open  it  by  art? 
I am  inclined  to  prefer  the  latter;  and  if  I 
could  be  assured  by  any  symptom  that 
suppuration  has  taken  place,  I should  not 
hesitate  to  make  a small  perforation  of  the 
Membrana  Tympani,  and  to  repeat  it,  if 
necessary,  taking  at  the  same  time  every 
precaution  to  suppress  the  fresh  collection 
of  matter. 

If  this  mode  of  treatment  were  followed, 
it  would  be  practicable  to  evacuate  the 
matter,  and  cure  the  complaint  with  trifling 
injury  to  the  Membrana  Tympani,  which 
is  generally  sacrificed  in  a spontaneous 
discharge. 

Most  frequently  the  establishment  of  this 
disease  is  slower  and  more  insidious.  Slight 
paroxisms  of  pain  attack  the  patient,  and 


60 


are  relieved  by  slight  discharges.  These 
recur  at  intervals,  until  at  last  the  puriform 
discharge  is  fully  confirmed. 

Some  practitioners  are  disposed  to  regard 
this  as  a trivial  disease,  others  as  one  too 
dangerous  to  allow  the  interference  of  art. 
Both  are  in  an  error.  It  is  without  doubt  a 
disease,  destructive  in  its  tendeney  to  the 
faculty  of  hearing.  It  rarely  stops  until  it 
has  so  much  disorganized  the  Tympanum 
and  its  contents  as  to  occasion  total  deaf- 
ness. On  this  account,  it  demands  the 
most  judicious  attempts  to  arrestits  progress, 
and  these  attempts  are  free  from  danger. 
How  the  contrary  opinion  should  have 
prevailed,  is  unaccountable;  yet  many  mo- 
dern practioners  condemn  all  attempts  to 
cure  it.  But  what  argument  can  be  ad- 
duced against  the  cure  of  this  disease, 
that  is  not  equally  conclusive  against  all 
others.  Is  any  one  an  abettor  of  the  obso- 
lete Humoral  Pathology?  He  will  contend 
that  the  stoppage  of  a drain  which  nature 
has  established  is  pernicious,  and  the  morbid 
matter  will  be  determined  on  the  internal 
parts;  but  how  can  such  a person  venture 


61 


on  tlie  treatment  of  any  disease,  even  the 
healing  of  a common  ulcer.  Some  years 
ago  I thought  this  absurd  doctrine  had  been 
totally  exploded,  and  yet  I constantly  hear 
it  adduced  to  deter  patients  from  interfering 
with  this  disease.  Is  a child  the  subject  of 
it?  The  parent  is  told,  it  is  best  to  leave  it 
to  nature,  and  the  child  will  outgrow  it. 
Is  it  an  adult?  Some  other  subterfuge 
equally  futile  is  employed.  The  truth  is, 
the  disease  is  always  tedious  and  difficult, 
and  not  always  curable,  and  many  are  dis- 
inclined to  embarrass  themselves  with  the 
case,  who  have  not  candour  to  make  the 
true  statement.  Thus  patients  are  induced 
to  refrain  from  all  attempts,  until  the  disease, 
in  its  first  stages  often  curable,  becomes 
absolutely  impracticable. 

The  celebrated  Heberden,  in  his  com- 
mentaries on  the  causes  of  diseases  and 
their  cure,  says  “ Frequens  puerorum  vi- 
“ tium  est,  interdum  quoque  adultorum, 
“ in  quo  Humor  mali  odoris  post  aures 
“ exit,  unde  tmnent  auriculae  et  loca  vicina 
“ et  cuticula  in  furfures  decedit.  Quod  si 
“ humor  acrior  fuerit  cutis  altius  exulcera- 


62 


“ tur.  Anris  autem  intus  malo  simili  inter- 
i{  dum  ajjicitur , ex  quo  seger  jit  sur  duster. 
“ Medicamenta  exsiccantia  nocent  verte.  do 
“ humorein  in  partes  interioves.  Nulla  alia 
“ curatione  opus  est,  nisi  ut  loca  aiiecta 
“ ssepe  abluentur  aqua  tepida,  et  ut  pannus 
et  unguento  aliquo  leni  delibutus  inter- 
“ ponatur,  ne  partes  vel  sibi  invicem  ag- 
“ glutinentur,  vel  hsereant  vestibus.”  It  is 
evident,  that  the  writer  applies  this  obser- 
vation principally  to  that  cutaueous  affec- 
tion of  the  auricle  to  which  new-born  in- 
fants and  very  young  children  are  subject, 
a trivial  complaint,  almost  unworthy  of  a 
place  in  so  grave  a book.  But  when  he 
says,  u Auris  autem  iutus  malo  simili  in- 
“ terdum  afficitur,  ex  quo  seger  fit  sur- 
“ daster,”  it  is  equally  clear,  that  he  al- 
ludes to  discharges  from  the  Meatus  Ex- 
ternus.  Now  I contend,  that  discharges, 
capable  of  making  the  patient  deaf,  must 
originate  from  the  Herpetic  ulceration  of  the 
Meatus  Externus,  or  a suppuration  of  the 
Tympanum.  In  the  former,  healing  me- 
dicines. “ medicamenta  exsiccantia,”  are  the 
only  medicines  which  ought  to  be  employed, 
and  I have  ample  proof  that  these  applica- 


63 


tions  will  cure  the  disease,  and  not  trans- 
late it  to  the  internal  parts.  In  the  latter, 
the  parts  affected  are  too  essential  to  per- 
fect hearing  to  be  neglected,  and  I shall 
prove  by  the  event  of  cases,  that  these  may 
be  healed  without  detriment  to  the  consti- 
tution. 

But  the  impropriety  of  attempting  the 
cure  of  this  disease  is  not  only  inculcated 
in  books;  many  eminient  practitioners  are 
tinctured  with  the  same  notion.  A short 
time  ago  I was  consulted  for  a case  of  puri- 
form  discharge  in  a young  lady,  who, 
having  heard  frequent  observations  from  a 
practitioner  of  the  old  school  on  the  trans- 
lation of  morbid  humours,  was  dubious  as 
to  the  safety  of  suppressing  it.  The  case 
was  referred  to  one  of  the  first  surgeons 
and  anatomists  in  this  metropolis,  who  de- 
cided against  all  attempts.  And  truly  for 
what  reason?  For  fear  of  injuring  the 
Brain!  The  brain  can  only  be  injured  by 
the  exposure  and  ulceration  of  the  Dura 
Mater,  and  the  application  of  substances 
capable  of  destroying  the  bone  and  Dura 
Mater  can  only  be  an  act  of  madness  or 


64 


the  grossest  ignorance.  But  injury  of  the 
brain  is  more  likely  to  result  from  the  con- 
tinuance of  this  disease,  than  the  judicious 
interference  of  art.  For  the  puriform  dis- 
charge naturally  advances  to  ulceration, 
and  ulceration  to  denudation  and  caries  of 
the  bone  and  separation  of  the  chain  of 
bones.  A caries  of  the  Tympanum  is  there- 
fore ultimately  produced.  But  this  will 
destroy  the  hone,  and  expose  the  Dura 
Mater;  and  if  it  were  not  for  that  princi- 
ple, by  which  membranes  that  line  cavities 
thicken  as  the  neighbouring  parts  arc  ul- 
cerating, and  thus  preserve  their  integrity, 
the  brain  would  perhaps  always  suffer  in 
the  ultimate  stage  of  the  puriform  discharge 
from  the  Tympanum.* 


* The  following  cases  from  Dr.  Duncan  Junior’s  “ Contri- 
butions to  Morbid  Anatomy,”  contained  in  the  68th  No.  of 
the  Edinburgh  Medical  and  Surgical  Journal,  illustrate  very 
happily  the  above  opinions;  the  brain  having  became  affected 
in  both  instances  by  the  continuance  of  the  disease,  with- 
out the  use  of  remedial  measures. 

« D.  S.  setat.  19,  was  admitted  on  the  31st  August,  1820, 
into  Queensberry-House, complaining  of  intense  headache, 
tenderness  of  abdomen,  and  great  prostration  of  strength, 
pulse  60.  These  were  treated  with  blisters  and  purgatives, 


65 


But  the  fact  is,  the  puriform  discharge 
from  the  Tympanum  often  exists  without 


but  suffered  no  abatement,  and  terminated  fatally  on  the 
morning  of  the  5th  of  September. — On  dissection,  a consi- 
derable portion  of  the  small  intestines  were  found  to  be  in- 
flamed, which  accounted  for  the  pain  referred  to  that  region. 
In  other  respects  the  abdominal  and  thoracic  cavities  and 
cerebrum  were  sound.  Nearly  all  the  right  lobe  of  the  cere- 
bellum was  occupied  by  an  abscess  containing  about  tpj,  of 
thick  pus.  No  traces  were  found  either  of  the  membranes 
or  bones  of  the  Tympanum;  its  cavity  was  filled  with  pus, 
and  a bunch  of  little  red  bags  containiug  fluid,  and  adhering 
by  a stalk  to  the  side. — There  was  a cylindrical  absorption 
of  bone  in  the  petrous  portion  of  the  Temporal  bone,  which 
was  softer  than  usual,  extending  from  the  transverse  sinus 
across  to  near  the  Cochlea. — His  sister  informed,  that  two 
years  ago  his  right  ear  was  pulled.  Ever  since  he  has  had 
severe  headache  and  deafness  of  that  side,  occasionally  there 
was  a thick  yellow  discharge  from  that  ear,  andjthen  he  en- 
joyed better  health;  latterly  his  judgment  became  impaired. 

J.  A.  jetat.  21,  admitted  into  Queensberry  Fever  Hospi- 
tal, 14th  November,  1820.  When  between  six  and  seven 
years  of  age,  his  right  ear  began  to  discharge  thick  yellow  pus, 
in  consequehce,  it  was  thought  of  cold,  and  has  continued  to 
run  ever  since,  with  occasional  intermissions  of  weeks  or 
months.  His  health  has  been  generally  good  and  not  af- 
fected by  the  state  of  the  discharge,  which  sometimes  chang- 
ed from  thick  and  yellow  to  a thin  and  watery  fluid;  occa- 
:onally  a little  blood  was  observed  to  flow.  Five  weeks  ago  he 

mvplained  of  violent  shooting  pains  in  the  affected  ear;  this 
ved  to  the  use  of  poultices  and  tepid  injections.  1 he  pain 

K 


66 


a caries  of  the  bone,  and  antecedently  to 
this  is  most  commonly  curable.  I have  so 


soon  remitted,  but  the  jaw  of  that  side  quickly  became 
affected,  as  his  friends  thought  with  rheumatism.  When 
the  pain  of  his  ear  remitted  some  blood  flowed,  and  the  , 
purulent  discharge  became  much  increased  in  quantity.  His 
complaints  for  nearly  three  weeks  continued  to  be  the  fixed 
pain  of  the  jaw,  together  with  great  constipation  of  his  bow- 
els, having  had  but  one  stool  in  twelve  days,  notwithstand- 
ing purgatives. — About  ten  days  ago,  after  being  exposed  to 
cold,  he  suddenly  complained  of  intense  headache;  his  head 
was  bent  forwards  upon  his  knees;  he  lost  his  voice;  in  about 
seven  hours  the  pain  went  off,  and  his  voice  returned.  After 
this  he  complained  of  oppression  only,  but,  as  his  father 
expressed  it,  was  not  himself  again.  Two  days  after  this 
last  attack,  he  was  brought  into  the  Hospital.  His  com- 
plaints were  obstinate  constipation,  slight  headache,  pain  of 
back  and  body,  stiffness  and  slight  curvature  of  neck  back- 
wards, also  delirium  of  a mild  kind.  Purgatives,  venesec- 
tion, and  antlspasmodics  were  freely  used;  frictions  and  sti- 
mulants were  appled  to  the  spine,  but  all  in  vain.  Bowels 
were  freely  opened,'  but  his  other  complaints  increased.  His 
neck  was  obstinately  drawn  back;  his  delirium  became  vio- 
lent, sighing  almost  incessantly,  and  upon  the  fifth  day  from 
admission  he  died. 

Dissection  — In  the  thorax  and  abdominal  cavities  were 
found  lb.  iv.  of  bloody  extravasated  fluid,  with  effusion  of  se- 
rum below  the  peritoneal  coat  of  the  bladder.  The  first  turn 
of  the  duodenum  contained  about  Ibss.  of  dark  coloured  fluid. 
At  this  part,  both  externally  and  internally  the  coats  of  the 
intestines  were  thick  and  black.  The  pericardium  contain- 
ed about  ^ij.  of  serum.  The  posterior  mediastinum  was 


67 


frequently  observed  this  disease,  that  I have 
no  hesitation  in  saying,  that  there  are  three 
stages  of  it: 


much  infarcted  with  black  blood. — The  spinal  marrow  from 
the  medulla  oblongata  to  the  second  or  third  dorsal  verte- 
bra was  softer  than  usual.  The  meningeal  linings  from 
this  place  downwards  were  much  distended,  and  on  slitting 
them  freely  open  gij.  of  pus  gushed  out.  This  had  dissect- 
ed and  separated  to  some  distance  the  fibres  of  the  cauda 
equina.  The  base  of  the  brain  presented  an  astonishing  ap- 
pearance of  disease.  All  the  nerves  at  their  origin  were  en- 
circled with  pus;  a part  of  the  right  anterior  lobe  was  disco- 
loured, opposite  to  the  dura  mater,  which  was  absorbed:  a 
large  abscess  was  found  in  this  lobe,  containing  thin  pus,  and 
portions  of  cortical  substance;  the  lateral,  third,  and  fourth 
ventricles  all  contained  pus.  The  petrous  portion  of  the 
temporal  bone  was  filled  with  pus. 

Mr.  Swan,  of  Lincoln,  in  the  same  number  of  the  Edinburgh 
Journal,  after  relating  a very  interesting  case  of  purulent 
discharge  from  the  Tympanum  of  the  Ear,  in  which  astrin- 
gent injections  appeared  to  be  the  principle  exciting  cause  of 
a very  alarming  vertiginous  affection,  but  which  terminated 
favourably;  makes  the  following  important  remarks.  “ When- 
ever a purulent  discharge  from  the  ear  is  attended  with  much 
complaint  of  the  head,  suspicions  ought  always  to  be  enter- 
tained that  the  dura  mater  is  irritated  in  consequence;  and 
on  any  increase  of  the  headache,  effectual  measures  should  be 
taken  to  arrest  the  progress  of  the  mischief  by  bleeding,  and 
a strict  atiphlogistic  regimen.  In  such  cases  we  ought  not 
to  wait  until  there  are  decided  symptoms  of  inflammation  of 
the  brain  or  its  membranes,  because  then,  as  cases  on  regard 


68 


First,  a simple  puriform  discharge. 

Secondly,  a puriform  discharge,  com- 
plicated with  Funguses  and  Polypi. 


show,  suppuration,  extending  some  way  on  the  base  of  the 
organ  can  hardly  ever  be  prevented;  but  the  remedies  I have 
mentioned  ought  to  be  used  immediately  on  the  increase  of 

pain  in  the  head  and  ear. 

/ 

To  those  who  have  not  much  considered  the  case,  these 
symptoms  may  not  seem  to  require  such  active  treatment; 
but  if  both  the  patient  and  practitioner’s  fears  are  suffered  to 
be  lulled  into  security  for  many  hours  after  their  approach 
by  palliatives,  the  disease  will  have  made  such  progress  as 
probably  to  resist  the  employment  of  every  thing  that  can 
be  done.  I consider,  therefore,  that  when  there  is  a discharge 
from  the  ear,  and  the  head  is  complained  of,  all  that  ought  to 
be  clone  is  an  attention  to  the  general  health,  and  an  at- 
tempt by  counter-irritation,  as  blisters  behind  the  ears  or 
on  the  back  of  the  neck,  to  remove  the  disease  from  the  ear. 
The  Meatus  ought  not  to  be  stopped  up  with  cotton  or  any 
other  substance  to  prevent  the  free  escape  of  the  matter,  as 
I am  convinced,  that  when  the  discharge  is  great,  such  a 
practice  is  very  wrong,  and  probably  not  only  adds  to  ti  e ir- 
ritation by  its  confinement,  but  may  lead  nature  to  attempt 
some  other  outlet,  and  thus  cause  an  absorption  of  the  bone^ 
and  consequent  exposure  of  the  dura  mater.  And,  upon  the 
whole,  I think  that  on  no  account,  in  the  case  where  the  dis- 
charge is  accompanied  by  pain  in  the  head,  ought  astringent 
injections  to  be  used  to  put  a stop  to  the  discharge,  as,  when 
it  has  been  stopped,  by  a perseverance  in  this  mode  of  treat- 
ment, the  brain  has  always  appeared  to  suffer,  and  the  con- 
sequences have  been  fatal.” 


69 


Thirdly,  a puriform  discharge  with  a 
caries  of  the  Tympanum. 

The  time  necessary  to  accomplish  the 
transition  from  one  stage  to  another  is  un- 
certain. Years  do  not  effect  it  in  some  in- 
stances, and  in  others  it  seems  to  advance 
almost  at  once  to  a carious  state  of  the  bone. 

The  puriform  discharge  from  the  Tympa- 
num is  a focal  disease,  and  does  not  de- 
pend on  any  vice  of  the  constitution.  Ge- 
neral remedies  are  therefore  very  ineffica- 
cious. But  as  a bad  state  of  health  is 
unfavourable  to  the  healing  of  any  parts, 
so  in  this  particular  complaint,  any  dis- 
ordered state  of  the  system  should  be  cor- 
rected. The  chief  dependence  is  to  be 
placed  on  direct  applications  to  the  parts 
affected. 

Blisters  and  setons  have  been  recom- 
mended by  some,  with  a view  to  effect  a 
derivation  of  the  humour.  If  they  are 
beneficial,  this  explanation  of  their  mode 
of  action  is  not  grounded  on  just  reasoning. 
Some  time  ago  I was  averse  to  their  use. 


70 


But  I now  think  they  may  he  advantage- 
ously employed  in  aid  of  topical  applica- 
tions. They  never  can  be  injurious,  ljut 
if  indiscriminately  adopted,  the  patient  will 
often  suffer  the  pain  and  inconvenience 
which  they  occasion,  without  reaping  any 
benefit. 

As  it  has  been  stated  that  the  degree  of 
deafness  produced  by  this  complaint  is 
various;  so  when  it  is  cured,  the  sense  is 
restored  in  different  degrees.  For  the  deaf- 
ness during  its  continuance  is  sometimes 
very  considerable  when  the  real  injury 
which  the  organ  has  sustained  is  trivial. 
In  the  first  stage  the  mere  thickening  of 
parts,  or  the  collection  of  the  discharge, 
must  impede  the  action  of  the  intervening 
machinery  between  the  external  and  in- 
ternal  parts  of  the  Ear;  and  in  the  second, 
the  mechanical  obstruction  of  the  Funguses 
or  Polypi  excludes  the  pulses  of  the  air. 
On  this  account  there  is  often  a notable  in- 
crease of  the  power  of  hearing,  when  the 
discharge  is  suppressed  in  the  first  and  se- 
cond stage.  But  as  the  parts  are  invisible, 
it  is  difficult,  if  not  impracticable,  to  decide 


71 


a pviove  how  far  the  power  of  hearing  can 
be  restored.  Now  this  is  no  valid  objec- 
tion to  undertaking  the  cure.  The  sense 
will  not  be  rendered  worse  by  a failure, 
and  if  the  discharge  should  be  stopped,  the 
disease,  which  caused  it,  is  removed,  the 
organ  safe  from  farther  injury,  and  the 
patient  freed  from  an  offensive  malady. 
This  argument  is  conclusive  in  favour  of 
treating  all  stages  of  the  disease,  hut  in 
the  last,  the  sense  is  almost,  if  not  totally, 
destroyed;  and  although  the  discharge  be 
stopped,  the  patient’s  hearing  will  be  very 
little,  if  at  all  improved. 

In  bavins:  stated  above  that  the  sense  of 
hearing  is  often  greatly  improved  by  a 
cessation  of  the  discharge,  it  must  be  un- 
derstood that  I confine  the  observation 
to  cases  of  the  first  and  second  stage,  in 
which  a great  part  of  the  machinery  of  the 
Tympanum  still  remains.  In  the  third 
stage,  the  chain  of  bones  is  nearly  destroy- 
ed, and  the  pus  seems  in  a certain  degree  to 
transmit  sounds.  I have  two  or  three  pa- 
tients at  present,  who  are  in  the  habit  of 
syringing  their  Ears.  They  can  distinctly 


72 


perceive  light  sounds  whilst  the  injected 
fluid  remains,  but,  on  its  escape,  again  be- 
come deaf. 


These  are  examples  of  caries,  and  al- 
though desirable  in  many  respects  to  stop 
the  discharge,  I am  inclined  to  think  that 
in  this  stage  hearing  would  not  he  im- 
proved. It  would  more  probably  he  di- 
minished; as  the  fluid  discharge  is  I think, 
a medium  by  which  the  pulses  of  the  air 
affect  the  seat  of  the  nerve. 

It  must  he  admitted,  that  the  event  of 
these  cases  is  not  always  gratifying  to  the 
practitioner.  Often,  when  he  has  done  his 
utmost,  no  great  degree  of  hearing  is  ac- 
quired; nor  can  the  discharge  always  be 
suppressed.  But  this  is  chiefly  attributable 
to  the  error  committed  in  allowing  the  dis- 
ease to  become  confirmed.  From  the  suc- 
cess which  has  attended  the  cure  of  many 
very  old  cases,  I have  every  reason  to  sup- 
pose that  those  which  are  recent  would  be 
still  more  successful.  From  the  popular 
prejudice,  encouraged  by  the  reluctance  of 
medical  men,  few  patients  apply  in  the 


73 


earlier  periods  of  the  disease.  They  wait 
until  their  patience  is  exhausted,  in  expec- 
tation of  a natural  cure,  and  when  they  do 
apply,  the  opportunity  is  passed. 

Nor,  according  to  my  observations,  are 
the  means  which  I have  seen  employed 
such  as  are  likely  to  succeed;  because  the 
treatment  corresponds  with  some  precon- 
ception of  its  nature  without  any  regard  to 
the  different  stages  of  the  disease.  One 
thinks  it  a caries  of  the  Tympanum.  He  has 
recourse  to  Tinct.  Myrrh se,  and  the  whole 
tribe  of  antiseptics.  A second  imagines  it 
consists  in  an  ulceration  of  parts,  and  treats 
it  with  as  little  delicacy  as  a common 
ulcer.  A third,  hearing  that  Vinum  Opii 
and  Calomel  are  beneficial  in  certain  dis- 
eases of  the  Eye,  employs  them  here  on  a 
forlorn  hope. 

If  a person  acts  from  the  impression  that 
this  disease  exists  only  under  one  form,  he 
will,  consistently  with  this  opinion,  employ 
one  general  remedy;  but  although  that 
remedy  should  not  be  improper,  he  cannot 
often  succeed.  The  different  stages  of  the 

L 


74 


disease  require  very  different  practice.  He 
only  can  be  successful  who  will  give  the 
greatest  attention  to  individual  eases,  and 
vary  his  means  agreeably  to  the  state  of 
each.* 

When  the  disease  is  cured,  the  healing 
process  is  effected  by  the  extension  of  the 


“ * The  first  stage  of  the  disease”  says  Mr.  Curtis  “ will 
often  yield  to  an  injection  of.the  sulphate  of  zinc,  used  night 
and  morning,  which  will  frequently  effect  a cure  in  the  space 
of  three  weeks  or  a month.  It  is  apt,  however,  to  leave  a 
a morbid  sensibility  of  the  ear,  which  occasions  pain  on  the 
entrance  of  loud  sounds.  The  plnmbi  superacetas,  or  sugar 
of  lead,  is  equally  useful  as  an  injection. 

In  some  cases  the  continuance  of  these  injections  has  been 
necessary  for  a considerable  length  of  time;  which  it  maybe 
proper  to  state  in  order,  first,  that  the  patient  may  not  look 
for  a speedy  cure;  and,  secondly,  that  he  may  be  induced  to 
persevere  a reasonable  length  of  time. 

In  the  second  stage  of  the  disease,  the  point  is  to  extract 
the  fungus  or  polypus,  with  a pair  of  small  forceps;  and,  if 
these  excrescences  do  not  come  entirely  away,  to  endeavour 
to  pinch  the  roots  till  the  whole  is  removed.  They  may 
then  be  touched  with  the  argentum  nitratum  as  before  men- 
tioned. 

On  the  removal  of  the  fungus,  or  polypus,  the  injection  of 
zinc  is  to  be  used;  and  in  a great  number  of  cases  the  hearing 
will  be  restored,  and  the  discharge  suppressed.’’ 


75 


Cutis  of  the  Meatus  into  the  Tympanum, 
and  its  becoming  continuous  with  its  Mem- 
branous lining.  1 have  a preparation,  a 
dissection  of  the  Ear,  in  which  half  the 
Membrana  Tympani  had  been  destroyed 
as  far  as  the  Manubrium  of  the  Malleus, 
around  which  the  Cutis  of  the  Meatus 
had  grown,  and  joined  the  lining  of  the 
Tympanum. 

After  the  cure  of  this  disease,  the  Tym- 
panum is  exposed  to  the  free  ingress  and 
egress  of  the  air,  and  the  mucilaginous  dis- 
charge inspissates  as  the  mucus  of  the  nose 
by  the  exhalation  of  its  watery  parts.  By 
this  accident  the  patient’s  deafness  increases 
at  intervals,  for  which  lie  often  seeks  relief. 
The  practitioner,  on  sounding  the  Ear,  per- 
ceives this  hardened  matter,  and  conceiv- 
ing, as  is  really  the  case,  that  it  produces 
the  augmentation  of  deafness,  is  tempted 
to  remove  it.  Ao thing  stimulative  can  be 
safe,  nor  any  rude  attempts,  for  there  is 
great  danger  of  reproducing  the  discharge. 
Having  learned  that  a discharge  has  pre- 
existed, it  will  be  expedient  to  leave  it  to  a 
spontaneous  separation. 


CASES  OF  THE  FIRST  STAGE 


I. 

Mrs.  S.  had  been  afflicted  with  a puri- 
form  discharge  from  the  Tympanum  for 
five  years.  On  blowing’,  with  the  nose  and 
mouth  closed,  air  occasionally  issued  at  the 
Meatus,  as  if  it  escaped  at  a narrow  orifice. 
The  discharge  was  very  great  1 could 
never  in  this  instance  render  the  bottom  of 
the  meatus  sufficiently  visible  to  ascertain 
the  degree  of  injury  which  the  Membrana 
Tympani  had  sustained.  The  escape  of 
air  was  a sufficient  demonstration  of  its  im- 
perfect state,  a symptom  which  still  con- 
tinues although  she  is  now  quite  well. 
Notwithstanding  the  length  of  time,  the 
disease  had  not  advanced  beyond  the  first 
stage.  It  jielded  in  the  space  of  a month 
to  an  injection,  night  and  morning,  of  a 
solution  of  Zincum  Yitriolatum.  The  de- 
gree of  deafness  in  this  instance  w as  trivial, 
and  she  hears  perfectly,  after  the  lapse  of 
two  years  and  three  quarters  since  the  sup- 


77 


pression  of  the  discharge,  nor  does  there 
appear  the  slightest  disposition  to  a relapse. 
The  only  remaining  defect  is  a morbid 
sensibility,  which  subjects  her  to  pain  when 
exposed  to  loud  sounds.  This,  perhaps, 
arises  from  the  inability  of  the  muscles  to 
regulate  the  tension  of  the  chain  of  bones 
and  the  remnant  of  the  Membrana  Tym- 
pani. 

II. 

Master  B.  had  laboured  under  a very 
great  degree  of  deafness,  occasioned  by  a 
puriform  discharge.  The  membrana  Tym- 
pani  in  this  instance  was  injured,  as  air 
could  be  blown  out  at  the  Meatus.  This 
case  also  yielded  in  two  months  to  the  use 
of  a solution  of  Zineum  Yitriolatum,  and 
the  patient  at  present  enjoys  nearly  perfect 
hearing. 

III. 

Mr.  S.  had  been  afflicted  with  a puriform 
discharge  from  the  Tympanum,  proved,  as 
in  the  former  instances,  by  the  expulsion 
of  air  at  the  Meatus.  The  deafness  was 
so  great,  that  the  tick  of  a watch  was 


78 


scarcely  perceptible  at  the  distance  of  three 
or  four  inches.  He  ay  as  cured  in  three 
months  by  a solution  of  Zincum  Yitrio- 
latum,  when  he  Yvas  able  to  distinguish  the 
tick  of  a Yvratcli  at  rather  greater  distance 
than  a yard. 

IY. 

Mary  Webb  applied  at  the  dispensary, 
afflicted  with  a very  great  degree  of  deaf- 
ness. Examining  the  Ears,  I found  a great 
discharge  from  each,  and  air  passed  out  at 
the  Meatus.  She  informed  me  that  it  had 
been  caused  by  the  Ear-ache,  that  one  Ear 
had  been  attacked  nine  months  before,  the 
other  only  two.  As  a certain  degree  of  in- 
flammatory action  still  remained,  I ordered 
the  Ears  to  be  fomented,  and  gave  the  pa- 
tient laxative  medicines  for  a few  days. 
She  then  commenced  the  use  of  a solution 
of  Zincum  Yitriolatum,  and  Yvas  cured  at 
the  end  of  seven  weeks.  One  Ear  regained 
its  perfect  functions,  the  other  was  consi- 
derably inferior;  but  even  this  was  capable 
of  distinguishing  conversation  with  readi- 


ness. 


79 


V. 

Mrs.  B.  applied  for  the  same  disease, 
with  symptoms  as  in  the  preceding  cases. 
The  deafness  was  very  great.  After  the 
use  of  a solution  of  Zincum  Yitriolatum  for 
four  months,  the  discharge  was  stopped, 
and  her  hearing  almost  completely  restored. 

VI. 

Ann  Thompson,  a child  w as  brought  to 
the  dispensary,  after  a suppuration  of  the 
Tympanum  in  one  Ear.  The  pus  had  been 
discharged  a few  days  preceding.  I purged 
the  child  briskly,  and  ordered  the  Ear  to 
be  fomented  for  a few  days.  I then  caused 
a solution  of  Cerussa  Acetata  to  be  injected 
three  times  a day.  At  the  end  of  five  w eeks 
the  discharge  ceased.  I could  not  perceive 
any  difference  between  this  and  the  sound 
Ear.  But  the  patient  being  a child,  only 
six  years  old,  I did  not  make  all  the  trials 
I could  have  wished. 

VII. 

Mr.  T.  applied  two  months  after  a sup- 
puration of  the  Tympanum.  The  deafness 


80 


was  considerable.  Air  passed  out  at  the 
Meatus.  He  was  cured  at  tbe  end  of  two 
months,  by  an  injection  of  Cerussa  Aoe- 
tata.  I ascertained  that  this  Ear  was  infe- 
rior one-fourth  to  the  other. 

VIII. 

Miss  B.  applied  on  account  of  a puriform 
discharge  from  both  Ears,  which  had  suc- 
ceeded frequent  attacks  of  the  Ear-ache. 
One  Ear  had  been  diseased  a long  time,  the 
other  only  a few  months.  The  Ear  last 
attacked  was  cured  in  three  w eeks,  and  the 
power  of  hearing  restored.  The  other  is 
considerably  improved,  but  the  discharge 
is  not  yet  suppressed,  although  astringent 
injections  have  been  used  a long  time. 


C ASES  OF  THE  SEC  OVD  STAGE. 

I. 

Mr.  G.  applied  in  consequence  of  deaf- 
ness. I learned  from  the  history  which  he 
gave  me,  that  he  had  been  afflicted  for 


81 


many  years  with  a puriform  discharge,  and 
air  had  passed  out  at  the  Tympanum.  At 
this  time  it  did  not  pass,  and  on  examina- 
tion 1 perceived  Funguses  at  the  bottom  of 
the  Meatus.  I attempted  to  extract  them 
with  a small  Forceps,  but  they  would  not 
sustain  the  pressure.  As  they  bled  freely, 
I destroyed  them  by  pinches.  For  some 
days  I used  a strong  solution  of  Alum. 
Finding*  that  the  Fung'uses  did  not  re- 
appear under  this  treatment,  I employed 
the  solution  of  Zincum  Yitriolatum,  as  in 
the  former  cases,  when  the  discharge  ceased, 
and  the  patient’s  hearing  was  remarkably 
improved. 

II. 

Mr.  F.  Surgeon,  came  under  my  care, 
being  afflicted  with  two  large  Polypi, 
which  protruded  at  the  Meatus.  lie  in- 
formed me,  that  long  before  their  appear- 
ance he  had  had  a puriform  discharge, 
w hich  was  very  profuse.  Some  time  before 
he  noticed  the  Polypi,  the  deafness  had 
become  total.  I extracted  both  with  the 
Forceps;  one  came  out  entire,  the  other 
was  torn,  and  the  root  remained.  I pinched 

M 


82 


and  tore  the  root  at  the  end  of  twenty-four 
hours,  and  forty-eight  hours  after,  w hen  the 
congealed  blood  had  separated,  touched 
it  with  the  Argentum  iSitratum.  He  left 
me  with  direction  to  inject  a solution  of 
Argentum  Nitratum,  and  under  this  ma- 
nagement the  discharge  stopped,  and  hear- 
ing was  restored. 

III. 

Mr.  H.  sought  to  be  relieved  from  a large 
Polypus,  which  came  out  at  the  Meatus. 
It  had  appeared  after  a puriform  discharge, 
which  had  continued  during  eight  years. 
For  a long  time  air  j>assed  out  at  the  Mea- 
tus in  blowing  his  nose.  This  symptom 
had  ceased  about  the  time  the  excrescence 
was  first  observed.  The  Polypus  was  ex- 
tracted and  brought  out  entire.  A few 
days  after  he  was  again  able  to  force  air 
out  of  the  Tympanum.  He  used  night 
and  morning  an  aluminous  injection.  At 
the  end  of  three  months  the  discharge  has 
ceased;  the  part  where  the  Polypus  grew 
is  cicatrized,  and  hearing  greatly  restored. 
Still  this  Ear  is  much  inferior  in  accuracy 
of  perception  to  the  other.  He  could  not. 


83 


at  the  time  of  his  application,  distinguish  a 
single  word  with  this  Ear,  with  which  he 
can  now  hear  a person  converse  in  a mo- 
derate tone  of  voice,  at  the  distance  of 
twelve  feet. 

IV. 

Master  B.  applied  in  consequence  of  a 
puriform  discharge  from  the  Tympanum, 
which  was  extremely  offensive,  and  was 
often  mixed  with  blood.  Such  was  its 
acrimony,  that  the  auricle  and  neck  were 
excoriated  by  it.  Air  had  formerly  passed 
out  at  the  Meatus,  as  it  would  even  now, 
in  the  course  of  repeated  efforts.  I exa- 
mined the  Ears,  and  found  Funguses  at  the 
bottom  of  the  Meatus.  The  deafness  was 
so  great,  that  I had  no  expectation  of  af- 
fording any  relief  in  respect  to  hearing. 
However,  I undertook  the  supression  of 
the  discharge.  On  account  of  the  Fun- 
guses, I used  the  Argentum  Nitratum.  He 
was  of  a weak  habit,  and  I therefore  admi- 
nistered the  Cinchona  as  an  auxiliary.  Ho 
applied  three  months  ago,  the  discharge  is 
greatly  diminished,  and  his  hearing  im- 
proved in  a remarkable  degree.  He  can 


84 


hear  clearly  what  is  said  to  him  in  a mo- 
derate tone  of  voice  at  the  distance  of  eight 
or  ten  feet. 


We  are  justified  by  the  event  of  these 
cases  in  drawing  the  conclusion,  that  the 
first  and  .second  stages  are  both  curable, 
and  that  the  ultimate  advantage  which 
hearing  derives  from  the  cure  of  tiie  se- 
cond, is  nearly  equal  to  that  of  the  first. 
The  apparent  advantage  is  much  greater. 
The  mechanical  obstacle  which  these  ex- 
crescences oppose  to  the  entrance  of  sound 
nearly  deprives  the  afflicted  person  of  his 
hearing.  The  patient  is  therefore  most 
agreeably  surpised  at  the  success  attend- 
ing their  extirpation.  But  in  the  eye  of  the 
practitioner,  Polypi  and  Funguses  are  only 
incidental  occurrences,  and  their  removal 
reduces  the  disease  to  the  first  stage.  The 
equality  of  success  cannot  therefore  excite 
his  astonishment. 


85 


Of  the  Obstruction  of  the  Eustachian  Tube. 

A very  great  degree  of  deafness  is  pro- 
duced by  an  obstruction  of  tbe  Eustachian 
Tube.  When  this  lias  happened,  air  can 
no  longer  be  admitted  into  the  cavity  of  the 
Tympanum,,  and  either  the  included  por- 
tion is  absorbed,  or  c-Ise  remains.  In  the 
latter  case,  the  included  air,  incapable  of 
yielding  in  any  other  way  than  by  conden- 
sation, counterbalances  the  pulses  excited 
by  sounding  bodies.  In  the  former,  the 
pressure  of  the  atmosphere  will  carry  the 
Membrana  Tympani  into  the  Tympa- 
num. as  far  as  it  can  go.  in  which  state  it 
will  rest,  and  cannot  vibrate  in  any  con- 
sideraMe  degree.  Each  hypothesis  ac- 
counts for  the  phenomenon.  But  I am  in- 
clined to  think,  that  subsequently  to  the 
obliteration  of  the  Eustachian  Tube,  the 
included  air  is  absorbed,  and  the  Tympa- 
num filled  with  Mucous.  I have  found  the 
cavity  in  this  state  in  two  instances  of  dis- 
section in  which  the  Eustachian  Tube  was 
closed. 


86 


The  obstruction  of  the  Tube  most  fre- 
quently arises  from  syphilitic  ulcers  in  the 
throat,  or  sloughing  in  the  Cynanclie  Ma- 
ligna. The  deafness  ensues  on  the  healing 
of  the  ulcers,  that  is,  when  the  obstruction 
is  complete.  The  descent  of  a nasal  Poly- 
pus into  the  Pharynx  and  enlarged  Ton- 
sils hare  also  been  known  to  close  the 
tube. 

If  the  patient  blows,  with  his  nose  and 
mouth  stopped,  he  does  not  experience 
that  peculiar  sensation  which  arises  from 
the  inflation  of  the  Tympanum.  He  speaks 
only  of  the  loss  of  the  sense,  and  complains 
of  no  particular  symptom.  The  deafness 
differs  in  this  respect  from  all  other  species, 
in  which  the  patient  is  harassed  with  most 
distressing  noises  which  are  false  percep- 
tions, arising  from  a diseased  state  of  the 
auditory  nerves,  or  proceeding  from  real 
impressions  on  the  nerves  produced  by  mor- 
bid causes  in  the  organ. 

Generally  the  obstruction  comes  on  in 
consequence  of  some  notable  disease  in  the 

■\  - 


87 


tin  oat,  and  the  cartilaginous  extremity  is 
most  commonly  the  seat  of  it.  Yet  it  oc- 
casionally takes  place  in  the  bony  portion 
of  the  Tube.  It  is  then  slower  in  its  pro- 
gress, proceeds  from  no  obvious  cause,  and 
consists  in  an  inordinate  ossification  filling 
up  the  canal. 

We  are  destitute  of  a perfect  diagnostic 
symptom,  by  which  we  can  be  assured 
when  deafness  is  produced  by  an  obstruct- 
ed Eustachian  Tube.  The  incapability  of 
inflating  the  Tympanum  only  renders  it 
probable.  Many  people  who  hear  perfectly 
are  incapable  of  producing  this  sensation, 
at  least  in  a great  many  trials.  We  are, 
therefore,  compelled  to  trust  to  the  pa- 
tient’s account.  This  will  be  sufficient 
when  the  obstruction  has  been  preceded 
by  an  ulceration  or  disease  of  the  throat. 
Otherwise,  the  patient’s  history  will  not 
always  conduct  to  the  discovery. 

The  world  is  indebted  to  the  observation 
and  penetration  of  Mr.  Astley  Cooper,  for 
restoring  the  hearing  which  this  obstruc- 
tion destroys.  He  had  observed  in  sup- 


88 


purations  of  the  Tympanum,  which  had 
injured  and  even  destroyed  the  Membrane 
Tympani,  that  the  sense  of  hearing  was 
only  impaired,  not  totally  lost;  and  that 
the  degree  of  deafness,  when  the  Mem  bran  a 
Tympani  was  only  injured,  by  no  means 
equalled  that  produced  by  the  obstructed 
tube.  Reflecting  on  this,  he  was  induced 
to  consider  that  a small  puncture  of  the 
Membrana  Tympani  would  be  of  trivial 
detriment  even  to  a sound  Ear,  and  in  this 
instance  would  be  the  means  of  restoring 
to  the  Organ  the  exercise  of  its  functions. 
This  happy  expedient  he  himself  executed 
with  great  success,  a success  fully  con- 
firmed by  a similar  result  of  the  operation 
in  other  hands. 

The  operation  is  performed  by  passing 
an  instrument  into  the  Meatus,  and  push- 
ing it  through  the  anterior  and  inferior  part 
of  the  Membrana  Tympani.  It  is  unneces- 
sary to  state  the  reason  for  making  the 
puncture  in  this  place.  The  position  of 
tliQ  Manubrium  of  the  Malleus  evidently  de- 
mands this  precaution.  A little  crack  will 
immediately  be  perceived  similar  to  whaf 


89 


is  occasioned  by  the  puncture  of  parch- 
ment, more  particularly  if  the  tube  be  closed, 
as  the  sound  will  then  be  more  acute,  from 
the  rapid  entrance  of  the  air  through  a 
narrow  aperture. 

The  instrument  ought  not  to  penetrate 
far  into  the  Tympanum,  lest  it  should 
puncture  its  vascular  lining,  as  the  escape 
of  blood  into  the  cavity  would  for  a short 
time  frustrate  the  operation,  even  if  it 
should  ultimately  be  successful. 

When  the  puncture  has  been  successfully 
made,  the  patient  is  instantaneously  re- 
stored to  perfect  hearing.  The  effect  of 
the  operation  is  the  immediate  substitution 
of  the  small  hole  in  the  Membrana  Tym- 
pani  for  the  Eustachian  Tube;  and  the  air 
being  admitted  into  the  Tympanum,  the 
mobility  of  the  Membrana  Tympani  returns, 
and  the  action  of  the  machinery  of  the 
Tympanum  is  re-established. 

The  only  obstacle  to  the  complete  suc- 
cess of  this  puncture  is  its  tendency  to  close. 
For  this  reason  it  is  often  necessary  to 

N 


90 


make  rather  a large  hole  in  the  membrane 
before  you  can  insure  the  patient  against 
the  recurrence  of  the  deafness.  But  a large 
hole  diminishes  the  perfection  of  the  sense. 
Tension  is  the  state  essential  to  the  Mem- 
brana  Tympani.  This  tension  is  not  dimi- 
nished by  a small  perforation.  But  if  the 
Membrana  Tympani  be  much  lacerated 
or  detached  at  its  circumference,  the  ten- 
sion will  be  lessened;  yet  even  then  the 
patient  receives  a striking  benefit.  To  this 
imperfection  we  must  however  submit,  and 
I am  inclined  to  think  a larger  opening 
expedient  than  what  can  be  made  by  a 
simple  perforation  with  the  instrument  pro- 
posed by  Mr.  Cooper. 

It  has  already  been  observed,  that  a per- 
fect diagnostic  symptom  is  a desideratum 
in  this  species  of  deafness.  If  a deafness 
be  accompanied  with  noise,  it  is  highly 
improbable  that  an  obstructed  Eustachian 
Tube  is  the  cause  of  it.  It  certainly  is 
not,  if  the  Tympanum  can  be  inflated. 

But  there  are  some  dubious  cases  of 
deafness  in  which  a surgeon  would  re- 


91 


luctantly  refrain  from  taking  the  chance  of 
this  operation.  In  such  he  cannot  do  wrong 
by  piercing  the  Membrana  Tympani.  It 
has  been  found  that  its  disposition  to  close 
is  very  great,  even  when  the  Eustachian 
Tube  is  impervious,  and  this  is  still  greater 
when  the  tube  is  open.  It  is  generally  re- 
united in  three  or  four  days,  but  if  the  open- 
ing should  remain  fistulous,  no  injury  re- 
sults from  it. 

It  would  be  superfluous  to  introduce  the 
particular  cases  of  success  which  are  re- 
lated by  Mr.  Cooper.  They  may  be  found 
in  his  paper  published  in  the  Philosophical 
Transactions  for  1802.  But  I am  authorized 
by  him  to  say,  that  Mr.  Bound,  whose 
case  is  there  mentioned,  continues  to  enjoy 
the  relief  he  at  first  experienced. 

The  following  case,  which  came  under 
my  own  care,  will  illustrate  what  lias  been 
advanced  respecting  the  closing  of  the 
puncture. 

Mr.  Gr.  K.  had  been  deaf  for  thirty  years. 
I could  scarcely  make  him  sensible  of  what 


92 


I addressed  to  him,  even  when  I spoke 
directly  into  his  Ear,  in  the  loudest  tone 
of  voice.  The  deafness  had  succeeded  the 
loss  of  a part  of  the  Palate  by  Syphilis. 
I had  no  doubt  from  the  manner  in  which 
he  had  become  deaf,  that  this  was  a case  of 
obstructed  Eustachian  Tube. 

I placed  him  in  the  sun,  and  passing  a 
probe  to  the  anterior  part  of  the  Membrana 
Tympani,  made  a small  perforation.  A 
crack  immediately  ensued,  and  in  the  space 
of  a few  seconds  he  heard  distinctly  the 
chirping  of  sparrows  on  a tree  at  a great 
distance.  In  a word,  his  hearing  was  per- 
fectly restored. 

In  the  space  of  three  days  his  deafness 
recurred,  and  at  the  end  of  a week  I again 
punctured  the  • Membrana  Tympani  with 
the  same  result.  Before  the  end  of  a week 
the  deafness  again  recurred,  and  at  the  end 
of  a fortnight,  I pierced  the  Membrana 
Tympani  a third  time  with  equal  success. 

The  opening  was  now  somewhat  larger: 
but  the  deafness  relapsed  in  a fortnight.  I 


93 


did  nothing  for  a few  weeks.  Seeing  no 
amendment,  I passed  a probe  through  the 
Membrana  Tympani,  and  extended  the 
opening  to  the  circumference.  He  was 
again  restored,  but  not  so  perfectly  as  be- 
fore. This  opening  I believe  remains  per- 
fect at  the  present  time. 


ON  THE  DISEASES  OF  THE  INTER- 
NAL PART  OF  THE  EAR. 

The  nature  of  the  deafness  which  arises 
from  the  Diseases  of  the  Internal  part  of  the 
Ear,  is  at  present  completely  obscure,  from 
our  great  ignorance  of  the  morbid  changes, 
which  are  the  immediate  cause  of  the  defect. 
If  we  reflect  on  the  component  parts  of  the 
Labyrinth,  we  cannot  refrain  from  coming 
to  the  conclusion,  that  it  originates  in  a want 
of  sensibility  in  the  nerve,  some  alteration 
in  the  structure  of  the  Membranes  on  which 
the  nerve  is  expanded,  or  change  in  the 
properties  of  that  fluid  which  is  contained 
in  the  Membranes,  and  is  the  immediate 
agent  in  impressing  the  sentient  extremities 


94 


of  the  nerve.  On  the  latter  head,  as  we 
are  informed  by  Mr.  Cline,  he  found  in  the 
dissection  of  the  Ear  of  a person  horn  deaf, 
that  the  labyrinth,  instead  of  its  aqueous 
fluid,  contained  a thick  caseous  substance. 
This  must  have  been  incapable  of  undula- 
ting in  the  cavities  of  the  labyrinth,  and  is 
fully  adequate  to  account  for  the  total  ab- 
sence of  the  sense. 

That  a total  deafness  may  exist  without 
any  defect  in  the  mechanism  of  the  exterior 
parts  of  the  Ear,  without  any  defect  in  the 
membranous  structure  on  which  the  nerve 
is  expanded,  in  the  water  which  it  contains, 
or  in  the  nerve  itself,  at  least  as  far  as  can 
be  traced  by  the  eye,  I have  myself  ascer- 
tained by  dissection. 

The  first  instance  was  the  Ear  of  a child, 
from  the  Asylum  for  the  deaf  and  dumb, 
which  died  at  Guy’s  Hospital.  The  disease 
was  such  as  caused  the  inspection  of  the  head 
after  death.  Mr.  Swift,  of  Oxford,  a student 
at  Guv’s,  cut  out  for  me  the  Os  Tern- 
poris.  I dissected  the  Ear  with  the  minutest 
attention,  and  could  not  perceive  the  slight- 


95 


est  defect  in  the  structure  of  the  parts. 
The  nerve  was  apparently  perfect,  and  I 
think  we  must  admit  that  the  deafness  arose 
from  an  original  want  of  power  in  the  nerve, 
caused  by  a deviation  from  its  natural  struc- 
ture too  minute  for  our  means  of  inspection, 
or  a deficiency  of  that  incrutable  principle 
on  which  its  functions  depend. 

The  second  was  a dissection  of  a man’s 
Ear,  who  died  of  a cancer  in  Guy’s  Hospital. 
He  was  a patient  of  Mr.  Cooper’s,  and  had 
been  deaf  for  many  years.  I was  equally 
unable  to  detect  in  these  ears  any  organic 
disease,  and  as  I knew  the  symptoms  were 
such  as  are  called  nervous  deafness,  I paid 
the  utmost  attention  to  the  condition  of  the 
labyrinth. 

The  whole  class  of  the  diseases  to  which 
the  internal  part  of  the  Ear  is  subject  may 
be  denominated  nervous  deafness.  In  this 
sense  it  is  a generic  term,  and  signifies  every 
disease  the  seat  of  which  is  in  the  nerve  or 
parts  containing  the  nerve.  But  in  its  ge- 
neral acceptation  the  term  is  more  specific. 


96 


The  general  character  of  this  class  is 
great  changeableness.  The  symptoms  are 
noises  in  the  head  of  various  kinds,  the 
murmuring  of  water,  the  hissing  of  a boil- 
ing tea-kettle,  rustling  of  leaves,  blowing 
of  wind,  £jc.  Other  patients  speak  of  a 
beating  noise  corresponding  with  the  pulse, 
and  increasing  by  bodily  exertion  in  the 
same  degree  as  the  action  of  the  hearts 
The  cause  of  this  impression  is  certainly  the 
pulsation  of  the  Arterial  system,  but  I con- 
fess myself  at  a loss  to  explain  what  the 
change  is  which  renders  the  organ  suscept- 
ible of  this  impression.  Nor  can  I at  all 
determine  whether  the  small  arteries  which 
ramify  in  the  interior  of  the  labyrinth  are 
the  immediate  agent,  or  the  internal  Ca- 
rotid, which  passes  close  beneath  the  Coch- 
lea. Whatever  be  the  cause,  the  species  is 
distinct,  nor  is  the  patient  who  has  this 
symptom,  affected  with  the  various  noises 
mentioned  before. 

All  these  confused  and  harassing  sounds 
are  false  perceptions  in  the  organ,  but  they 
arise  less  frequently  (if  I may  so  say)  in  the 


97 


nerve  itself,  than  from  the  condition  of  the 
parts  about  the  nerve.  I formed  this  con- 
clusion from  observations  on  syphilitic  deaf- 
ness, of  which  the  following  is  a striking 
instance,  and  it  evidently  depended  on 
some  change  in  the  labyrinth. 

Mr.  B.  applied  to  me,  in  a case  of  ex- 
treme deafness.  He  complained  of  various 
sounds,  as  the  blowing  of  wind,  rustling  of 
leaves,  &jc.  which  were  so  loud,  that  he 
often  could  with  difficulty  disbelieve  their 
reality.  I examined  the  Ear,  and  there 
was  no  wax,  and  on  blowing  his  nose,  he 
inflated  the  Tympanum.  I considered  it 
a case  of  nervous  deafness,  and  despaired 
of  rendering  him  any  service.  But  as  it 
was  not  of  long  standing,  and  he  laboured 
under  a great  heaviness  and  dejection  of 
countenance,  and  had  a white  tongue,  X 
was  tempted  to  try  how  far  the  deafness 
might  he  relieved  by  the  mitigation  of  the 
constitutional  disorder.  I therefore  pre- 
scribed. In  about  three  weeks  he  com- 
plained of  having  a cold  and  sore  throat. 
I found  a syphilitic  ulcer.  On  putting 

him  under  a course  of  mercury,  the  ulcer 

o 


98 


healed  in  a fortnight.  But  the  patient  had 
taken  mercury  five  -weeks  before  his  hearing: 
was  much  improved.  In  fine,  he  recovered 
his  hearing  completely,  and  all  the  symp- 
toms subsided. 

In  two  or  three  other  cases  of  syphilitic 
deafness  the  symptoms  have  been  precisely 
the  same,  and  the  event  a cessation  of  the 
symptoms  and  recovery  of  hearing. 

When  I reflected  on  the  event  of  these 
cases,  I could  not  but  consider  that  some 
change  had  been  produced  in  the  structure 
of  parts  adjacent  to  the  nerve,  and  had 
been  the  proximate  cause  of  the  symptoms, 
rather  than  that  the  nerve  itself  had  been 
affected.  It  is  the  most  reasonable  infe- 
rence, as  the  mercury,  which  cured  it,  is 
more  calculated  to  exhaust  than  impart 
energy  to  the  nerves. 

Being  forcibly  struck  with  the  congruity 
between  deafness  produced  by  Syphilis  and 
the  concomitant  symptoms  of  nervous  deaf- 
ness, I could  not  avoid  concluding,  that 
although  the  remote  cause  he  different,  the 


99 


proximate  cause  is  the  same  in  each.  Ana- 
logous to  this  is  defective  vision,  arising 
from  opacity,  which  may  result  from  com- 
mon inflammation  or  specific.  In  this  case 
the  immediate  cause  is  the  deposition  of 
Lymph. 

The  change  from  the  specific  cause  in 
either  instance  is  most  manageable,  because 
we  are  furnished  with  a remedy,  which,  as 
soon  as  its  action  is  produced,  arrests  the 
progress  of  the  disease.  But  as  the  opacity 
in  a syphilitic  ophthalmia  is  often  too  far 
organized  to  be  absorbed,  so  in  syphilitic 
deafness,  when  the  syphilis  is  cured,  the 
effect  is  often  irremovable,  and  the  injury 
to  the  function  of  the  affected  organ  per- 
manent. There  is  a period,  therefore,  at 
which  syphilitic  deafness  is  irremediable, 
and  this  is  more  remarkably  the  case  with 
nervous  deafness. 

Having  satisfied  myself  that  the  proxi- 
mate cause  of  syphilitic  and  nervous  deaf- 
ness was  the  same,  I was  determined  to  try 
the  success  of  an  analogous  treatment  in  a 
recent  case  of  nervous  deafness.  I was  soon 


100 


furnished  with  an  opportunity  of  bringing 
tills  to  the  test. 


CASES  OF  INCIPIENT  NERVOUS 
DEAFNESS, 

SUCCESSFULLY  TREATED. 

J. 

J.  Walton  applied  at  the  dispensary  for 
relief.  He  had  been  extremely  deaf  for 
two  months.  The  Meatus  contained  little 
wax,  and  he  could  inflate  the  Tympanum. 
He  complained  of  noises  in  his  head,  such 
as  I have  described  above.  His  deafness 
was  so  great,  that  I could  scarcely  make 
him  hear  what  I said.  lie  was  a robust 
man,  and  plethoric. — I put  him  on  a most 
rigid  diet,  and  gave  active  cathartics  three 
times  a week.  For  the  first  fortnight  the 
doses  were  Calomel  Gr.  viij.  at  night,  and 
Natron  Vitriolat.  Oz.  iss.  in  the  morning. 
Blisters  were  also  applied  behind  the  Ears 
three  times  successively  at  intervals  of  a 


101 


week.  He  continued  on  tills  plan  for  six 
weeks,  the  cathartics  being  regulated  accor- 
ding to  circumstances.  His  hearing  was 
now  restored,  but  slight  noises  still  remain- 
ed. He  was  much  reduced,  and  I gave 
him  small  doses  of  Calomel  every  night, 
and  Sarsaparilla  twice  a day  for  a fortnight. 
The  noises  had  now  left  him,  he  was  put  on 
liis  usual  diet,  and  took  Cinchona.  At  the 
end  of  ten  weeks  he  was  perfectly  well. 

Ill 

J.  Clinch,  a lad,  applied  at  the  dispensary, 
afflicted  with  a very  great  degree  of  deafness. 
The  noises  in  his  head  were  trivial,  com- 
pared with  the  other  case.  He  had  little 
wax,  and  could  inflate  the  Tympanum. 
He  could  hear  a watch  tick  at  only  three 
inches  from  his  Ear.  I applied  blisters  be- 
hind the  Ears  four  times  successively,  at 
intervals  of  a week.  He  took  every  night 
Calomel  Gr.  if.  twice  a week  a solution  of 
Magnesia  Vitriolata.  At  the  end  of  five 
weeks  he  heard  a watch  tick  at  the  distance 
of  a }7ard.  He  was  a good  deal  reduced, 
and  I changed  the  plan  to  the  Cinchona. 
Tie  left  me  at  the  end  of  two  months,  w hen 


102 


lie  could  distinguish  the  tick  of  a watch  at 
rather  greater  distance  than  a yard. 

III. 

Wm.  Higgins,  a boy,  applied  at  the 
dispensary.  He  had  been  very  deaf  six 
weeks.  He  had  little  wax,  could  inflate  the 
Tympanum,  and  had  no  catarrhal  symp- 
toms. He  was  always  complaining  to  his 
mother  of  singing  and  noise  in  his  Ears. 
He  was  treated  with  three  blisters  in  suc- 
cession, at  intervals  of  a week;  took  Calomel 
Gr . iss.  every  night,  and  a solution  of  Mag- 
nesia Yitriolata  twice  a week.  He  wag 
perfectly  cured  at  the  end  of  five  weeks. 

IV. 

Wm.  Bygrave  had  been  deaf  for  two 
months  with  singing  and  noise  in  his  Ears. 
The  symptoms  were  the  same  as  in  the 
other  instances.  His  health  was  in  other 
respects  very  good.  The  diminution  of 
hearing  was  much  less  than  in  the  other 
cases,  and  yielded  to  the  use  of  two  blisters, 
brisk  cathartics,  and  rigid  diet,  in  a little 
more  than  three  weeks. 


iOS 


V. 

Win.  Harvey  applied  at  the  dispensary. 
He  had  been  exceedingly  deaf  for  six 
months;  otherwise  in  perfect  health.  In 
blowing  his  nose,  air  passed  into  the  Tym- 
panum, §c.  The  noises  in  his  head  were 
perpetual,  and  harassed  him  much.  He 
was  treated  very  much  in  the  same  manner 
as  the  other  cases.  He  experienced  but 
a trifling  relief  at  the  end  of  three  weeks. 
I almost  despaired  of  success,  and  was 
principally  induced  to  persevere  by  his 
anxiety  to  be  cured.  He  continued  the 
blisters  for  two  months,  gradually  growing 
better  in  that  time,  so  as  to  hear  a w atch 
tick  at  about  tw  o yards,  although  when  he 
first  applied  he  w as  obliged  to  place  it  in 
contact  with  his  Ear. 

VI. 

3.  Kirwan,  a lad,  applied  at  the  dispensary 
on  account  of  a deafness  of  some  months. 
His  symptoms  w ere  precisely  as  those  men- 
tioned in  the  former  cases.  His  general 
health  perfect.  He  was  cured  on  the  same 
plan  as  the  others,  in  three  weeks. 


104 


I shall  not  weary  the  reader  with  the 
recital  of  any  more  cases.  These  are  suffi- 
cient to  establish  the  point  that  the  incipient 
state  of  these  symptoms  may  be  relieved, 
and  that  a strict  antiphlogistic  treatment 
and  means  of  promoting  absorption  ought 
to  he  employed. 

Confirmed  nervous  deafness  is,  without 
doubt,  hopeless,  but  I know  not  a priori 
how  to  determine,  when  attempts  are  vain. 
This  does  not  altogether  depend  on  the 
time  but  the  decree  of  mischief  done  to  the 
organ,  and  the  periods  at  which  it  becomes 
incurable  must  he  various.  The  case  of 
longest  standing  is  that  of  V.in,  Harvey. 
This  did  not  yield  until  the  plan  had  been 
carried  to  an  extreme,  to  which  few  patients 
would  be  inclined  to  submit.  Beyond  this 
time  I should  think  irremediable. 

My  object  is  to  direct  the  attention  of  the 
practitioner  to  the  commencement  of  this 
species  of  deafness.  When  early  applica- 
tion is  made,  it  behoves  him  to  take  the  case 
seriously  in  hand,  for  no  time  is  to  be  lost 


105 


and  active  means  in  the  beginning  will 
often  succeed. 

It  is  far  from  my  inclination  to  excite  a 
hope  that  old  cases  of  this  species  of  deafness 
admit  of  cure.  I have  never  seen  or  heard 
of  any  cured  by  any  plan  of  treatment 
whatsoever,  and  as  to  the  various  vaunted 
remedies  with  which  the  public  prints  are 
daily  teeming,  1 know  them  to  be  abso- 
lutely inefficacious,  and  often  prejudicial. 
^*^*^*****^ 
Mr.  Curtis  divides  the  Diseases  of  the  In- 
ternal Ear  into  the  constitutional  and  local, 
Or  such  as  influence  it  from  a morbid  condi- 
tion of  the  brain  or  other  parts  of  the  body, 
and  such  as  arise  from  a change  in  its  own 
particular  structure. 

“ Of  all  the  causes  of  deafness,”  he  ob- 
serves, “ that  which  proceeds  from  an  orga- 
nic affection  of  the  brain  is  the  most  danger- 
ous. In  apoplectic  cases,  with  faultering  of 
speech  and  blindness,  we  find  deafness  also 
produced  by  the  general  affection  of  the 
head.  But  worst  of  all  is  the  case  where  a 
tumour  of  the  brain  compresses  the  origan 

r 


106 


of  the  nerves;  for  here  the  deafness  is  com- 
plete, and  no  impression  can  be  conveyed 
through  the  organ  to  the  mind.” 

“ A tumour,  however,  in  the  vicinity  of 
the  organs  of  hearing,  though  it  runs  its 
course,  and  proves  fatal  in  the  end,  has  ra- 
ther a contrary  effect:  and  even  while  the 
pupils  are  dilated,  and  there  is  every  appear- 
ance of  pressure  on  the  brain,  a morbid 
acuteness  takes  place,  in  consequence  of  the 
surrounding  inflammation.  Indeed,  the  au- 
ditory nerve  often  becomes  acutely  sensible 
in  disease,  or  the  patient  suffers  from  acute- 
ness of  perception,  or  has  a tinitus  aurium, 
or  singing  of  the  ears,  analogous  to  the  flash- 
es of  light  which  sometimes  affect  the  eves 
in  total  blindness,  and  which  those  experi- 
ence who  are  blind  of  cataract.  So  morbid- 
ly acute  does  sensation  become  in  some  per- 
sons under  disease,  that  the  least  motion  of 
the  head  will  excite  a feeling  like  the  ring- 
ing  of  a great  bell  close  to  the  ear.” 

“ In  delirium  also,  in  vertigo,  in  apoplexy, 
and  in  hysteria,  the  increased  sensibility  of 
the  organ  becomes  a painful  sensation.  In 


107 


paralytic  affections  of  the  face,  we  find  there 
is  deafness  of  the  corresponding  ear,  if  the 
affection  of  the  nerve  be  near  the  brain; 
which  is  explained  by  the  intimate  connex- 
ion between  the  auditory  nerve  and  the  com- 
municating one  of  the  face.  From  observ- 
ing the  course  of  the  latter  nerve  through 
the  temporal  bone,  and  its  connexion  in  the 
Tympanum,  we  know  why,  in  violent  tooth- 
ache, and  in  tic  doule'reux,  we  find  the 
Eustachian  Tube  and  the  root  of  the  tongue 
affected.” 

“ The  Ear  is  also  sometimes  affected  by 
sympathy,  from  foulness  of  stomach  and 
bowels;  and  the  same  reason  may  be  assigned 
for  the  symptom  of  Hypo'chondriasis — that 
they  are  affected  with  strange  sounds,  and  in 
the  case  of  intestinal  worms,  we  find  mur- 
muring, and  ringing  of  the  Ears  a symp- 
tom.” 

“ Deafness  in  acute  fever  is  considered  a 
favourable  sign;  as  it  argues,  according  to 
the  old  theory,  a metastasis  or  translation  of 
the  morbific  matter;  or  rather,  according  to 
modern  opinion,  it  shews  a diminution  of 


108 


morbid  sensibility  of  the  brain.  The  accu- 
mulation of  blood  in  the  vessels  of  the  brain, 
or  those  surrounding  the  auditory  nerve, 
will  also  produce  deafness,  and  unusual  sen- 
sations of  the  Ear.  This  we  find  instanced 
in  suppression  of  the  menses,  and  in  hem- 
orrhoids, indigestions,  &jc.  in  which  cases 
it  is  found  preceded  by  vertigo  and  head- 
ache.” 

“ In  comparing  the  diseases  of  the  Ear 
and  the  Eye,  we  find  a considerable  analogy 
subsisting  between  them;  but  in  those  of 
the  eyes  there  is  one  advantage,  that  the 
transparency  of  its  humours  is  a leading 
mark  to  direct  us,  which  we  do  not  possess 
in  the  case  of  the  Ear;  but  in  judging  of  the 
diseases  of  the  Internal  Ear,  we  should  al- 
ways endeavour  to  determine,  whether  it  is 
in  the  seat  of  sense  or  in  the  brain  that  the 
real  affection  lies:  otherwise  our  attempts  to 
relieve  will  be  ineffectual.” 

“ All  the  forms  of  nervous  deafness  may 
be  considered  as  peculiar  modifications  of 
constitutional  disease,  affecting  the  nervous 
system  in  general,  and  connected  with  that 


109 


state  which  constitutes  tlie  hypochondriac 
and  hysterical  habit.  The  general  morbid 
disposition  is  here  extended  to  a particular 
sense,  and  by  viewing  it  in  this  light  the 
change  of  the  constitutional  affection  must 
form  the  basis  of  the  cure.  It  is  by  consi- 
dering it  in  this  just  point  of  view  that  pro- 
per principles  of  treatment  can  only  be  adopt- 
ed, and  that  much  may  be  done  to  remove 
this  species  of  the  complaint.  The  hysteri- 
cal spasm  of  the  throat  and  primse  vise  be- 
comes naturally,  from  the  connexion  and 
sympathy  of  nerves,  communicated  to  those 
of  the  Ear,  and  deafness  in  most  cases  is  a 
never  failing  symptom  with  hysterical  pa- 
tients. In  the  same  maimer  that  torpor  of 
the  stomach  and  primse  vise,  so  characteris- 
tic of  hypochondriasis,  occasions  a dull  sen- 
sation and  torpor  of  the  auditory  nerve,  and 
produces  that  noise  and  confused  impres- 
sion so  often  complained  of  in  hypochon- 
driasis.” 

“ A wide  field  therefore,  opens  here  for 
new  principles  of  treatment,  by  attacking  the 
constitutional  cause,  and  that  much  relief 
may  be  obtained  by  the  adminstration  of 


110 


constitutional  means,  experience  daily  evin- 
ces. It  is  from  not  keeping  that  analogy 
in  view  that  nervous  deafness  is  sg  formida- 
ble to  most  Surgeons.” 

“ These  cases  of  nervous  deafness,  when 
our  Ear  only  is  affected,  are  in  general  ren- 
dered worse  by  the  conduct  of  the  patients 
themselves;  for  when  the  organ  of  one  side 
is  injured,  we  hear  so  much  better  with  the 
other,  that  we  only  attend  to  the  sensation 
conveyed  by  it,  and  neglect  the  duller  sensa- 
tion. The  effect  of  this  is,  that  the  diseased 
ear  becomes  worse,  and  the  same  conse- 
quence arises  as  that  which  takes  place  in  the 
Eyes  by  squinting.” 

“ In  attending  to  the  treatment  of  ner- 
vous deafness,  if  the  practitioner  is  early  ap- 
plied to,  and  the  disease  is  still  in  its  first 
stage,  it  may  be  considered  in  general  as  cu- 
rable; and  even  cases  of  long-standing,  when 
properly  treated,  admit  of  considerable  re- 
lief.” 

“ A strict  antiphlogistic  course,  if  the  pa- 
tient be  able  to  bear  it,  will  often  prove  sue- 


Ill 


cessful;  namely,  powerful  saline  cathartics, 
of  which  the  best  is  the  vitriolated  magne- 
sia: the  doses  should  be  repeated  as  often 
as  the  strength  of  the  patent  will  admit;  and 
in  the  intermediate  time  small  doses  of  the 
submuriate  of  mercury  are  to  be  admin- 
istered to  promote  absorption,  by  taking  off 
any  thickening  of  the  parts,  which  is  apt  to 
impede  the  due  performance  of  the  functions 
of  the  organ.” 

“ This  practice  will  in  incipient  cases  suc- 
ceed; and,  if  not  completely,  will  at  least  pal- 
liate the  predominant  symptom,  and  in  all 
cases  it  ought  to  have  a fair  trial,  for  deaf- 
ness should  never  a priori  be  considered  as 
incurable.” 

“ With  respect  to  the  application  of  topi- 
cal remedies  to  the  Ear,  gentle  stimulants, 
in  form  of  linament,  as  a portion  of  the  es- 
sential oils  mixed  with  oil  of  almonds,  may 
be  beneficially  introduced  into  the  Ear, 
where,  being  retained,  they  will  serve  as  a 
substitute  for  the  natural  secretion,  and  at 
the  same  time  increase  the  sensibility  of  the 
passage.  All  the  advertised  nostrums  are 


112 


preparations  of  this  kind;  and,  so  far  as  they 
supply  the  secretion,  and  gently  stimulate 
the  passage,  in  some  cases  they  may  be  use- 
ful: but  as  to  the  notion  that  they  are  to  re- 
move an  organic  affection  of  the  part,  the 
various  species  of  which  have  been  descri- 
bed, it  only  shows  the  complete  ignorance  of 
those  who  expect  success  from  such  inade- 
quate means  of  relief.” 

As  so  little  can  be  done  by  medicine  in 
confirmed  cases  of  deafness  of  long  "stand- 
ing, arising  from  imperfect  organization  of 
the  Ear,  Mr.  Curtis  has  with  much  pains 
collected  a variety  of  contrivances  to  assist 
hearing,  many  of  which  he  has  obtained  from 
the  Continent,  in  order  to  give  all  possible 
relief  in  such  distressing  cases. 

“ The  newest  inventions  of  this  kind,  are 
the  artificial  Ears  lately  introduced  from 
France,  w here  they  were  originally  manu- 
factured. By  being  closely  adapted  to  the 
Ear,  they  increase  the  collection  of  sound; 
but  besides  that,  there  is  an  additional  force 
wranted  to  transmit  it  through  the  passage. 
In  this  respect,  the  French  invention  is  de- 


113 


ficient;  to  remedy  its  defect  Mr.  Curtis  lias 
added  a small  tube,  which,  by  contracting 
the  passage,  will  occasion  the  sound  to  en- 
ter with  greater  impetus.  This  invention 
is  found  very  convenient,  in  consequence 
of  the  substitutes  being*  applied  over  the 
natural  Ear,  which  they  are  made  to  resem- 
ble. 

The  Spanish  Ears  also,  made  of  shells 
answer  very  well:  but,  at  the  same  time,  it 
is  worthy  of  remark,  that  these  mechanical 
contrivances,  although  found  to  be  more  ser- 
viceable than  any  thing  of  the  kind  in  gene- 
ral use,  yet  do  not  apply  with  equal  success 
in  all  cases;  and  there  are,  in  fact,  cases  in 
which  no  mechanical  contrivance  can  be  of 
use- 

With  some  patients  the  German  Silver 
Ears  answer  better  than  any  others;  but  are 
objected  to  by  many,  on  account  of  their 
weight,  and  being  more  conspicuous  than 
the  French  Ears;  it  also  being  necessary 
that  they  should  be  fixed  by  a spring,  which 
goes  over  the  head. 

Q 


114 


The  French  Ears,  being  made  of  a light 
substance,  where  they  answer  the  purpose, 
are  generally  preferred. 

Mr.  Curtis  has  also  invented  a hearing- 
trumpet,  forming  a parabolic  conoid,  on  the 
same  principle  as  the  speaking  trumpet 
used  at  sea,  which  is  so  well  known  to  answer 
the  purpose  in  extending  the  impression  of 
sound.  It  has  this  convenience,  that  it 
shuts  up  in  a small  case  for  the  pocket. 

Cases  extracted  from  Mr.  Curtis'  zcork,  il- 
lustrative of  the  Treatment  of  Constitu- 
tional or  Sympathetic  Deafness. 

& “ Sarah  Gjreen,  five  years  of  age,  was 
brought  by  her  mother  to  the  If  ova  l Dis- 
pensary on  the  3rd  day  of  May.  The  child 
appeared  very  deaf,  and  of  a listless  aspect: 
by  her  mother’s  account  she  passed  restless 
nights,  gnashed  her  teeth  during  sleep;  ap- 
petite various,  at  one  time  indifferent,  at  ano- 
ther voracious.  The  child’s  appearance  was 
sickly,  the  eye  languid  and  heavy,  counte- 
nance pale,  and  the  upper  lip  somewhat 
tumeffed;  the  bowels  were  irregular,  and  the 
stools  dark  and  offensive.” 


115 


Suspectingfrom  the  deranged  state  of  the 
digestive  functions,  that  the  deafness  might 
he  sympathetic  of  this  affection,  I felt  inclin- 
ed to  try  the  effects  of  gentle  emetics,  re- 
peated twice  a week,  with  calomel  interven- 
ing. I shortly  had  the  satisfaction  to  find 
the  stools  less  foetid,  the  appetite  more  natu- 
ral, and  the  general  health  and  appearance 
of  the  child  to  improve;  as  these  changes  for 
the  better  took  place,  a corresponding  alter- 
ation in  the  local  affection  of  the  Ear  ac- 
companied these  salutary  and  flattering 
changes  in  the  constitution.  In  short,  with 
a restoration  to  good  health,  there  was 
also  a complete  recovery  of  the  sense  of 
hearing.  Ko  worms  were  observed  to  pass 
by  stool,  and  the  child  remains  perfectly 
well.” 

“In  about  a week  after  the  last  case  was 
dismissed  cured,  Master  Macnamara,  a fine 
boy,  about  nine  years  of  age,  was  brought 
to  my  house  labouring  under  similar  symp- 
toms. From  the  efficacy  of  emetics  in  the 
case  of  Sarah  Green  I had  recourse  to  them 
in  this;  and  without  detailing  the  symptoms 
at  length,  and  the  progressive  and  siraulta- 


116 


neons  disappearance  of  the  disorder  of  the 
system  and  the  sympathetic  affection  of  the 
Ear,  suffice  it  that  their  use  appeared  equal- 
ly appropriate,  and  their  effect  was  equally 
beneficial.” 

“ Master , the  son  of  a worthy  Ba- 

ronet, was  exceedingly  deaf  when  brought 
to  me.  He  too  was  of  a pale  complexion 
and  languid  appearance,  ground  his  teeth 
when  asleep,  and  often  when  awake  pick- 
ed his  nose;  his  bowels  and  appetite  were 
irregular;  stools  foetid  and  dark-coloured, 
belly  hard  and  tumid,  and  frequently  he 
complained  of  griping  pains  about  the  um- 
bilicus.” 

Emetics  were  had  recourse  to  without 
effect,  but  as  the  symptoms  of  w orms  were 
unequivocal,  he  was  put  on  a course  of 
strong  anthelmintics,  and  vermes  of  the 
lumbrici  kind  were  passed  in  abundance. 
The  general  health  shortly  after  this  im- 
proved daily,  and  what  proves  that  the  hear- 
ing was  affected  sympathetically,  was  the 
restoration  of  this  sense  on  the  other  com- 
plaints, being  got  rid  of.” 


117 


“No  topical  means  were  applied  in  these 
cases,  but  the  cure  was  wholly  affected  by 
having  detected  and  remedied  the  remote, 
yet  indubitable  source  of  the  deafness.” 


EXPLANATION 


OF 

THE  PLATES. 


PLATE  I. 


This  Figure  represents  a section  of  the  Cranium  and  Face, 
made  for  the  pupose  of  shewing,  in  one  view,  the  Meatus 
Externus,  the  Membrana  Tympani,  and  Eustachian  Tube, 
that  the  relative  position  of  these  parts  may  be  distinctly 
comprehended. 

The  right  side  of  the  Face  is  removed  by  means  of  two 
sections,  a longitudinal  and  a transverse,  the  former  of  which 
is  made  a little  on  the  right  of  the  Septum  Nasi,  the  latter 
a little  before,  and  parallel  with  the  Meatus  Externus.  The 
two  sections  incline  towards  each  other,  and  meet  at  an  ob- 
tuse angle. 

The  right  side  of  the  Velum  Palati  Mollis  is  separated 
from  the  bony  palate,  and  the  Pharynx  preserved  and  dis- 
played in  a lateral  view. 

The  anterior  part  of  the  Meatus  Externus  is  opened  from 
the  beginning  of  the  Tragus  to  the  Membrana  Tympani, 


PI  II 


i 19 


which  lies  at  the  bottom,  and  separates  it  from  the  Tympa- 
num. The  anterior  part  of  the  Eustachian  Tube  is  also  op- 
ened, and  a probe  lies  in  it,  and  passes  from  its  orifice  in  the 
upper  and  lateral  part  of  the  Pharnyx  into  the  Tympanum, 
which  is  left  unopened. 

a.  The  Meatus  Externus.  The  letter  is  placed  exactly 
at  the  junction  of  the  bone  and  cartilage  which  compose 
this  Canal. 

b.  The  Membrana  Tympani. 

c.  The  Eustachian  Tube,  with  a probe  in  it.  The  head  of 
the  probe  serves  to  mark  the  aperture  of  the  right  nostril  in 
the  Pharynx/ 


PLATE  II. 

Fig. I. 

This  Figure  represents  an  interior  view  of  the  Membrana 
Tympani  and  Eustachian  Tube,  which  have  been  divided 
from  the  petrous  portion  of  the  Os  Ternporis  by  a transverse 
section,  and  of  the  lateral  part  of  the  nostril  divided  from  the 
Septum  Nasi,  with  a portion  of  the  Velum  Palati  Mollis  and 
Pharynx  annexed.  It  is  given  with  the  design  of  shewing 
the  relative  position  of  the  aperture  of  the  Eustachian  Tube 
to  the  Membrana  Tympani,  and  its  oblique  course  from  the 
Tympanum  to  the  spot  where  the  Nostril  and  Pharynx  com- 
municate. 

a,  The  Eustachian  Tube. 

b.  The  Membrana  Tympani. 


120 


c.  The  Malleus  attached  to  the  Membrana  Tympani. 

d.  The  Chorda  Tympani  passing  over  the  Malleus  and 
Membrana  Tympani. 

e.  The  section  of  the  Pharynx. 

/.  The  section  of  the  Velum  Palati  Mollis. 


Fig.  II. 

This  Figure  represents  a dissection  of  the  Os  Temporis 
to  shew  the  chain  of  bones  between  the  Membrana  Tympani 
and  Vestibule,  precisely  in  their  proper  situation;  for  the 
bone  is  so  cut  that  the  Stapes  rests  on  the  lower  part  of  the 
Fenestra  Ovata,  the  Malleus  is  attached  to  the  Membrana 
Tympani,  and  the  Incus  is  in  its  articulation  near  the  aper- 
ture of  the  Mastoid  cells. 

a.  The  Malleus. 

b.  The  Incus- 

c.  The  Stapes. 

Fig.  III. 

This  Figure  represents  a dissection  of  the  Ear,  in  which 
the  anterior  part  of  the  Meatus  Externus  is  cut  off,  and  the 
Tympanum  opened.  The  Eustachian  Tube  is  also  opened, 
and  the  view  of  it  is  the  same  as  in  Plate  I.  This  Figure 
shews  the  Membrana  Tympani,  the  Malleus,  and  Tensor 
Membranse  Tympani  attached  to  it.  As  the  Tympanum  is 
opened,  the  size  of  this  cavity  may  be  judged  of,  as  well 
as  the  degree  of  convexity  which  is  proper  to  the  Mem- 
brana Tympani,  circumstance  best  observed  in  a lateral 
view. 


a.  The  Meatus  Externus. 


pi.  m 


b.  The  Membrana  Tympani. 

c.  The  Eustachian  Tube. 

d.  The  Malleus. 

e.  The  Tensor  Membranse  Tympani,  sending  its  tendon 
through  a little  foramen  of  bone,  and  inserted  into  the  Manu- 
brium of  the  Malleus. 


PLATE  III. 

Fig.  I. 

This  Figure  represents  the  Foetal  Os  Temporis;  to  shew 
the  slender  bony  ring  that  contains  the  Membrana  Tympani. 
This  ring  is  elongated  by  subsequent  ossification  into  that 
considerable  process  of  the  adult  bone,  called  by  Osteologists 
the  Meatus  Auditorius  Externus. 

a.  The  Ring  of  bone. 

b.  The  Membrana  Tympani. 

Fig.  II. 

This  Figure  represents  in  different  positions  the  indivi- 
dual bones,  which  form  the  chain  of  connexion  between 
the  Membrana  Tympani  and  the  Membrane  of  the  Vesti- 
bule. 

1.  A view  of  the  Malleus,  as  seen  within  the  Tympa- 
num. 

a.  The  Manubrium. 

b.  The  Head. 

c.  The  Processus  Gracilis. 

R 


122 


2.  A View  of  the  Malleus,  as  seen  from  the  Meatus  Ex- 
ternus. 

a.  The  concave  portion  of  the  Manubrium,  the  extremity 
of  which  reaches  the  centre  of  the  Membrana  Tympani. 
The  whole  of  this  surface  is  attached  to  the  Membrana  Tym- 
pani. 

b.  The  articular  surface  on  the  head  for  its  junction  with 
the  Incus. 

3.  A view  of  the  Side  of  the  Incus,  that  faces  the  Mem- 
brana Tympani. 

a.  The  longer  Crus. 

b.  The  shorter  Crus. 

c.  The  articular  surface  for  its  junction  with  the  Mal- 


4.  A View  of  the  Side  of  the  Incus,  that  faces  the  Laby- 
rinth. 

• a.  The  longer  Crus,  having  the  Os  Orbiculare  on  its  ex* 
tremity. 

b.  The  shorter  Crus,  which  articulates  in  a depression 
close  to  the  aperture  of  the  Mastoid  Cells. 

j5.  A View  of  the  Stapes,  as  seen  by  a person  who  holds 
it  with  the  base  towards  him,  and  the  straight  part  of  the 
base  lowermost,  and  looks  at  the  same  time  into  the  hollow 
of  its  Crura. 

a.  The  Head. 

b.  The  Base. 

c.  The  two  Crura,  of  which  the  most  incur vated  lies  to- 
wards the  Mastoid  process. 

6.  A View  of  the  Incus  and  Stapes  articulated  to  shew  the 
intervening  Os  Orbiculare. 


Ieu3. 


a.  The  Os  Orbiculare. 


123 


7.  A View  of  the  whole  chain  of  bones,  articulated,  with 
the  Tensor  Membranae  Tympani,  adhering  to  the  Manu- 
brium of  the  Malleus. 

Fig.  III. 

This  Figure  represents  the  exterior  portion  of  the  Mas- 
toid process  and  Tympanum,  both  having  been  divided  by 
a vertical  section,  to  exhibit  the  Mastoidal  cells,  the  inter- 
nal surface  of  the  Membrana  Tympani,  and  the  Portio 
Dura  of  the  Auditory  Nerve,  turned  out  of  the  Stylo-mas- 
toid canal.  The  section  is  continued  beyond  the  Tympa- 
num, and  cuts  the  Os  Sphenoides  in  such  a manner  as  to 
make  a section  of  the  Foramen  Spinosum,  the  Foramen 
Ovatum,  and  to  separate  the  Ala  Minor  from  the  body  of 
the  Os  Sphenoides  directly  within  the  Foramen  Opticum 
By  the  section  of  the  Os  Sphenoides  the  Inferior  Maxillary 
nerve  is  laid  bare,  and  the  angle  of  the  lower  jaw  remains 
to  shew  one  of  the  branches  of  this  nerve,  viz.  the  Dental, 
entering  the  Dental  canal.  The  object  is  to  shew  tke 
Chorda  Tympani,  and  its  connexion  with  the  sublingual 
branch  of  the  Inferior  Maxillary  and  the  Portio  Dura  of 
the  Auditory  Nerve.  On  this  account  both  these  nerves 
are  dissected  and  displayed.  The  precise  course  of  the 
Chorda  Tympani  through  the  Tympanum  is  demonstrated 
by  the  preservation  of  the  Malleus  and  Incus  in  their  proper 
situation..  It  lies  on  the  Membrana  Tympani,  passing  over 
the  Manubrium  of  the  Malleus,  between  it  and  the  longer 
Crus  of  the  Incus. 

a.  The  Mastoidal  cells. 

b.  The  Membrana  Tympani. 

c.  The  Portio  Dura  of  the  Auditory  Nerve,  turned  out 
of  its  canal;  and  the  little  twig  of  the  Chorda  Tympani 
going  off  through  the  bone  to  enter  the  Tympanum  is 
marked  <*. 


124 


d.  The  Inferior  Maxillary  Nerve. 

e.  The  Dental  branch. 

f.  The  Sublingual  branch. 

g.  The  Chorda  Tympani. 

Fig.  IV. 

This  Figure  represents  the  interior  portion  of  the  Mas- 
toid Process,  the  interior  part  of  the  Tympanum,  viz.  that 
part  which  is  opposite  to  the  Membrana  Tympani,  and  the 
Eustachian  Tube,  connected  with  the  Tympanum.  This 
View  is  given  by  a section  similar  to  that  of  the  last  Figure; 
and  allowing  for  the  variation  of  different  subjects,  and  a 
slight  deviation  of  the  Saw,  the  two  portions  laid  together 
would  compose  a complete  Ear.  The  Stapes  remains  in 
situ , fixed  in  the  Fenestra  Ovata,  and  the  Tendon  of  the 
Stapedus  Muscle  is  seen  inserted  into  its  head.  Its  base  is 
concealed  in  the  hollow  of  bone  that  bounds  the  Fenestra 
Ovata.  The  Fenestra  Rotunda  is  visible,  situated  a little 
below  the  Stapes.  This  section  also  exposes  the  Portio 
Dura  of  the  Auditory  Nerve,  which  winds  between  the 
Tympanum  and  Mastoid  cells.  At  one  part,  the  Horizon- 
tal Canal  is  close  to  it,  and  is  here  opened,  that  the  proxi- 
mity may  be  observed.  The  Internal  Carotid  Artery  is  also 
dissected  and  introduced.  Its  course  behind  the  part  of  the 
Tympanum  which  is  elongated  into  the  Eustachian  Tube, 
and  its  contiguity  to  the  Cochlea,  appear  in  this  Figure. 

a.  The  interior  supeijices  of  the  Tympanum.  The  line 
which  marks  it  is  drawn  from  the  elevation  of  the  surface 
that  covers  the  apex  of  the  Cochlea. 

b.  The  Eustachian  Tube  slit  open. 

c.  The  Stapes. 

d.  The  Tendon  of  the  Musculus  Stapedeus,  issuing 
through  a little  foramen  in  the  bone. 

c.  The  Fenestra  Rotunda. 

f.  The  Portio  Dura  of  the  Auditory  Nerve. 


r 1 


PI.  IV 


125 


g.  The  Horizontal  Canal. 

ft.  The  Internal  Carotid  Artery. 

Fig.  V. 

This  Figure  represents  a portion  of  the  interior  Superfi- 
cies of  the  Tympanum  dissected  to  shew  the  Stapedeus  Mus- 
cle and  the  Canal  of  bone,  which  lodges  the  Tensor  Mem- 
brane Tympani. 

a.  The  Musculus  Stapedeus,  dissected  by  opening  the 
bone  which  contains  it. 

b.  The  Stapes,  receiving  the  Tendon  of  the  Musculus 
Stapedeus. 

c.  The  Canal  of  the  Tensor  Membranae  Tympani. 

d.  The  little  hole  through  which  the  tendon  of  the  Ten- 
sor Membranae  Tympani  is  deflected. 

Fig.  VI. 

This  Figure  represents  the  Skeleton  of  the  interior  super- 
ficies Of  the  Tympanum  (the  Mastoidal  Cells  being  in  out- 
line) that  the  Fenestra  Ovata  and  Fenestra  Rotunda  may  be 
seen. 

a.  Fenestra  Ovata. 

b.  Fenestra  Rotunda. 


PLATE  IV. 


Fig.  I. 

This  Figure  represents  a dissection  of  that  part  of  the 
Labyrinth  which  forms  the  interior  superficies  of  the  Tym- 
panum. The  position  of  the  central  cavity,  the  Vestibule, 
may  be  known  by  the  Fenestra  Ovata.  The  Cochlea  is 
placed  before  the  Vestibule,  with  its  apex  inclined  towards 


126 


the  Tympanum,  and  below  the  horizontal  line.  The  two 
turns  and  half  of  the  Spiral  Tube  (the  Spiral  Lamina  being- 
removed)  are  shewn,  and  the  communication  of  this  Tube 
with  the  Vestibule.  A portion  of  the  V ertical  and  Horizon- 
tal semi-circular  Canals  are  opened  and  traced,  as  far  as 
' they  can  be  seen  in  this  view. 

a.  The  Meatus  Internus. 

b.  The  Cochlea:  the  line  is  drawn  from  its  apex; 

c.  The  Vertical  semi-circular  Canal. 

d.  The  Horizontal  semi-circular  Canal. 

Fig.  II. 

This  Figure  represents  a dissection  of  the  Occipital  side 
of  the  Os  Temporis,  to  shew  the  Meatus  Internus;  the  Ob- 
lique semi-circular  canal,  and  the  junction  of  its  smaller  ex- 
tremity with  that  of  the  Vertical. 

a.  The  Meatus  Internus. 

b.  The  Oblique  Canal. 

c.  The  Vertical  Canal. 

d.  The  common  part  of  the  two  Canals.  , 

Fig.  III. 

This  Figure  is  copied  from  Professor  Scarpa.  It  is  a 
magnified  view  of  the  larger  Membranous  Sac  of  the  Vesti- 
bule, and  the  Membranous  semi-circular  Canals,  and  is  in- 
tended to  illustrate  the  distribution  of  the  Portio  Mollis  upon 
them. 

a.  The  Sac  in  which  the  semi-circular  Canals  and  Scala 
Vestibuli  terminate. 

b.  The  Vertical  Canal. 

c.  The  Oblique  Canal. 

d.  The  common  termination  of  the  Vertical  and  Oblique 
Canals. 

e.c.  The  Termination  of  the  Horizontal  Caral. 


427 


f.  The  Portio  Mollis. 

g.g.  The  Portio  Dura. 

h.  The  Branch  of  the  Portio  Mollis  supplying  the  Sac  of 
the  semi-circular  Canals. 

i.  The  Branch  of  the  Hemispherical  Sac. 

k.  The  Twig  supplying  the  Ampulla  of  the  Oblique  Canal. 

l.  The  Fasciculus  of  the  Cochlea. 

Fig.  IV. 

This  Figure  represents  a dissection  of  the  Cochlea,  in 
which  the  Scala  Vestibuliis  cut  open  through  its  whole  ex- 
tent, and  the  Cochlea  is  set  upon  its  base,  that  the  observer 
may  be  able  to  judge  ofits  height.  This  dissection  is  design- 
ed to  shew  the  Spiral  Lamina,  with  its  Membrane,  that 
makes  the  Septum  between  the  Scala  Vestibuli  and  Scala 
Tympani,  which  remains  closed. 

a.a.a.  The  turns  of  the  Spiral  Lamina,  or  Septum. 

b.  The  Fenestra  Ovata. 

c.  The  Fenestra  Rotunda. 

d.  The  Apex  of  the  Cochlea. 

Fig.  V. 

This  Figure  represents  a dissection  of  the  Cochlea,  in 
which  the  Cochlea  rests  on  its  base,  and  one  side  of  the  Sca- 
la V estibuli  is  opened.  The  section  exhibits  the  appearance 
of  three  compartments,  and  a portion  of  the  Septum  of  the 
Scala  is  seen  in  each.  Its  principal  object  is  to  shew  the 
little  hole  by  which  the  two  Scalae  of  the  Cochlea  communi- 
cate. To  understand  this  Figure,  the  reader  must  observe 
that  the  Scala  Tympani  is  not  touched,  that  it  begins  under 
the  Septum,  at  the  Fenestra  Rotunda,  makes  parallel  turns 
with  the  Scala  Vestibuli,  and  terminates  at  the  common  Fo- 
ramen of  the  Apex. 

a.a.a.  The  turns  of  the  Spiral  Septum. 

b.  The  Fenestra  Ovata. 

c.  The  Fenestra  Rotunda. 


128 


d.  The  Hole  of  communication  between  the  Scalse. 

Fig.  VI. 

This  Figure  represents  an  oblique  section  of  the  Cochlea 
on  the  side  of  the  Meatus  Internus.  It  lays  open  both  the 
Scalre,  the  portion  of  the  Canal  below  the  Spiral  Lamina  be- 
ing the  Scala  Tympani,  that  above,  the  Scala  Vestibuli. 

1.2. 3.4.  The  edges  of  bone,  made  by  the  section  of  the 
Spiral  Tube:  1.2.  the  cut  edges  of  the  first  turn — 2.  3.  ditto 
of  the  second  turn: — 3 and  4.  ditto  of  the  third  or  half  turn, 

a.  The  first  turn  of  the  Spiral  Lamina. 

b.  The  second  turn. 

c.  The  third  or  half  turn. 

Fig.  VII. 

This  Figure  represents  a dissection  in  which  the  Spirai 
Lamina  is  left  in  connexion  with  the  Modiolus  and  the  Ves- 
tibule, from  which  it  derives  its  origin.  The  Fenestra  Ova- 
ta  and  the  aperture  of  the  Scala  Vestibuli  are  laid  into  one, 
by  breaking  down  the  partition  between  them. 

a.a.a.  The  turns  of  the  Spiral  Lamina  and  the  Modiolus. 

b.  The  cavity  of  the  Vestibule. 

c.  The  hole  of  communication  between  the  Seals. 

Fig.  VIII. 

This  is  a magnified  view  of  Fig.  7,  to  shew  the  Plexu3  ot 
the  Portio  Mollis  in  the  Spiral  Lamina,  on  the  side  of  the 
Scala  Vestibuli. 

Fig.  IX. 

A magnified  view  of  a similar  section  to  that  of  Fig.  5, 
with  the  exception,  that  the  third  turn  cf  the  Spiral  Tube  is 
-not  opened.  It  is  left  closed,  because  the  half  tun.  r the 
Spiral  Lamina  is  too  minute  to  admit  of  the  ne»  - :s  being 
seen  in  this  view.  It  is  meant  to  shew  the  Plexus  of  the 
Portio  Mollis  in  the  Spiral  Lamina  on  the  side  of  the  Scala 
Tympani. 


FINIS. 


; ' 


W: , 


f 


l ■ . 


